
Class. 



"RCg/ 



Book 



A^:_ 



\ 



Medical admonitions 



TO 



FAMILIES, 

RESPECTING THE 

PRESERVATION OF HEALTH, 

AND THE 

TREA TMENT OF THE SICK, 

ALSO, 

A TABLE OF SYMPTOMS, 

&ERtriNG TO POINT OUT THE DEGREE OF DANGER, AND, TO DIST{$3USSH ONE 
DISEASE FROM ANOTHER : 

WIT ri 

OBSERVATIONS 

ON THE IMPROPER INDULGENCE OF CHILDREN.* &C* 



By JAMES PARKINSON, m. », 



HOXTON. 



How best the fickle fabric to support 
Of mortal man ; in healthy body how 
A healthful mind thd longest to maintain. 

ARMSTRONG. 



JFirgt atncrican, from tfie jfaunS €ttglfelj Saitfim* 

PORTSMOUTH, New-Hampshizs : 
Printed for CHARLES PEIRCE,by N. S. & W. PEIRCE, 

" . ' 1803. 



INTRODUCTION 



TABLE of SYMPTOMS, 

IN the moll trifling affairs, hardly any one will 
be found who will entruft another, with the per- 
formance of any bufinefs of the nature of which he 
is uninformed, 

Should any one be afked to truft another with 
the turning of a toothpick, out of fome fubitance 
which he valued, merely on the recommendation 
of his having an excellent fet of tools, and an effay 
on the art of turning, he would confider that fome 
practice would be neceffary to give him the art of 
turning the wheel, with due velocity and regu- 
larity, and of holding the tool, and of applying it in 
the moft proper manner. He would remark that 
repeated obfervation and experience were required, 
dve a knowledge of the grain of various fub- 
s, and in what direction the grain of differ- 
ent 



4 MEDICAL ADMONITIONS. 

ent fubftanees mould be worked ; and that with? 
out this knowledge, he would be likely to ftuver 
to pieces the fubftance on which he operated, in- 
ftead of making it affume an ufeful and beautiful 
form. He would therefore fay, No, you mull ex- 
cufe me, I muft apply to fpme artift of more judg- 
ment and ability, for I will not have my toothpick 
fpoiled. But often when life itfelf is at flake, much 
lefs circumfpe&ion is employed than in the turning 
of a toothpick — the treatment of fome dangerous 
difeafe is confided to any one who pofleffes a medi- 
cine cheft and the fmall fliare of fkill which is de- 
rived from the perufal of fome treatife on domeflic 
medicine. 

To deftroy the ftrange infatuation on which fuch 
fnconfiftency depends, would be a hopelefs endea- 
vour ; but humanity fuggefts, nay, commands, 
that every thing be done which may be likely to 
Jeffen the evils refulting from it. If men will, in 
fpite of remonftrance, rufli into danger, they are 
not, therefore, to perifh unaided. Should any one 
obftinately put to fea without a compafs to fteer 
by, and without any knowledge refpecting the nav- 
igating of a fhip j but what he picks up during 
his voyage, by reference to fome treatife on navi- 
gation, it would not be fufficient, merely to endea- 
vor to diffuade him from making the raih attempt. 

But 



MEDICAL ADMONITIONS. jj 

But if he perfift, every poflible affiftance fhould be 
yielded him : the perils he has to fhun fhould be 
clearly pointed out, the different rocks and quick- 
fands he is to avoid, fhould be marked ; and the 
different circumftances fhould be defcribed which 
may fhow his near approach to danger. 

With a fimilar intention, is the following table 
given ; it is by an attention to fymptoms, that the 
phyfician is enabled to fteer his courfe with confi- 
dence and fafety, and to difcover the dangers which 
threaten. By a reference to the following table, 
and by examining the fymptoms moft prominent 
at the commencement of difeafe, domeftic pracli- 
tioners therefore, may more readily detect the dif- 
eafe which they wifh to remove j and will be then 
better able to determine, as to the propriety of 
taking the tafk of curing it on themfelves. If this 
be refolved on, a reference to the table may alfo 
ferve to fhow the degree of danger which is marked 
by any particular fymptom, which may arife in 
the progrefs of the diforder 3 and which calls for 
very powerful affiftance. 



TABLE 



SYMPTOMS. 



ANXIETY. 

vVHEN fever is accompanied by extreme anx» 
iety, the patient fuftaining, at the fame time, a 
eonliderable lofs of fpirits and ftrength, the fever 
may be judged to be of a malignant kind, and to 
require the moft powerful aid. 

APHTHA, fee Thrush. 

APPETITE, loss of 5 
When accompanied by fqueamifhnefs, vomitings 
distention and pain of the ftomach, eructations 
and heart-burn, tveaknefs of the Jiomach has taken 
place ; demanding a judicious regulation of the 
diet* and the ufe of corroborant remedies. 

Returning in fevers and other acute difeafes, a iign 
of a fpeedy recovery. 

For 



8 MEDICAL ADMONITIONS. 

For things, feemingly improper, may often be in. 
dulged, in fever, not only without any ill confe- 
quence, but frequently with confiderable advan- 



tage. 



BELLY, pain of, in lying-in women. 
If within a few days after delivery, a confiderable 
degree of forenefs and pain is experienced in the 
belly, preceded by cold fhiverings ; the pulfe 
becoming quick and fmall, the fkin dry, the head 
and back painful, the breathing difficult, and the 
patient oppreffed with exceffive anxiety and 
dejection of fpirits ! there is great reafon to fup- 
pofe the Puerperal Fever, as it is termed, has come 
on : requiring the moft judicious and prompt 
exertions. 

Violent pain of, chiefly pofleffing the parts about 
the navel, vomiting and obftinate coftivenefs, 
with fever, ihow the exiftence of iiifiammation of 
the bowels, a difeafe which in general terminates 
fatally in a very few days, if proper remedies 
are not early adopted. 

Griping pains of, chiefly about the naval, accom- 
panied by troublefome urgings, and generally 
preceding flimy or mucous ftools, in which fmall 
ftreaks of blood are perceivable, fliow the difeafe 
to be Dyfentery or Bloody Flux. 

BLOOD, 



Medical admonitions. 9 

BLOOD, raifed by Coughing. 
In every cafe in which blood is raifed by coughing, 
it may be concluded that fome blood-veffel in 
the lungs is ruptured. This circumflance is gen- 
erally followed by Conmmption, to mention this 
inuft be fufficient to induce early attention, 

Raifed by vomiting. 
Blood thus difcharged, muft proceed from the 
ftomach ; and except in cafes of interrupted 
menflrual difcharge, is attended with no' fmall 
degree of danger. 

Spitting of, without cough or vomiting, 
This always proceeds from the mouth only, and is 
therefore unaccompanied by danger. 

Difcharged from the Noftrils. 
This feldom occurs but in fuch a ftate of the fyftem 
as demands great care, that by a fpare regimen 
and a due employment of exercife, fuch a degree 
of' fulnefs of the blood-veffels be prevented, as 
may produce Confumption in the young, or Apo- 
plexy in the aged. 

Flowing from the Fundament* 
This may in general be concluded to proceed from 
the Piles, if this be not the cafe, fome internal 
mifchief is to be feared, 

B BLOODY 



IO MEDICAL ADMONITIONS; 

BLOODY STOOLS, >> BELLY, 

GRIPING PAINS OF, 

BREAST, SWELLING OF. 

This fymptom fometimes comes on, as the difeafe, 
termed the Mumps, fubfides, but is always with- 
out danger. 

SMALL KERNAL IN. 
When a fmall, hard, moveable and painful kernel 
appears in the breaft, a Cancer may be appre- 
hended to be forming ; and therefore the moll 
fpeedy afliftance fhould be obtained. 

BREATHING, short. 
Frequent little cough, with fliortnefs of breathing, 
pain in fome part of the cheft, and fever, denote 
Inflammation of the Lungs, which if not removed 
within the iirft two or three days of the difeafe, 
will either occafion death fpeedily, or produce a 
lingering Confwnption. 

BREATHING, difficult. 
The breath drawn in with a loud wheezing found, 
and the voice hoarfe, with a Couch accompanied 
by a drill barking found, Ihow the difeafe to be 
the Croup or Inflammation of the Wind Pipe ; the 
removal of which can only be obtained by the 
employment of proper means, in the firji hours 
of the exiftence of the difeafe. 

Returning 



MEDICAL ADMONITIONS, J I 

Returning, by fits, accompanied by a fenfe of tight- 
nefs acrofs the cheft, marks the difeafe to bf 

Afthma. 

CONVULSIONS, 

In children, often precede the Small Pox? 

Frequently accompany dentition, and may, in gene- 
ral, be fpeedily cured, by properly lancing the 
gums. 

Often occafioned by worms irritating the ftomach 
and bowels. 

Of the whole body, with frothing at the mouth, 
and total lofs of fenfibility, characterife Epilepfy, 
or the Falling Sicknefs ; fo termed from the fub- 
je&s of this difeafe falling fuddenly on the com- 
ing on of the .fit. 

With a fenfation as if a ball was riling in the throat, 
flutterings and rumbling in the bowels, fhow 
the difeafe to be Hyjlerics. 

COSTIVENESS. 
Obftinate coftivenefs, with fevere pain and con- 
traction of the belly, point out the Colic. 

When it happens to the makers of white lead, 
painters, lapidaries, &c. there will be reafon to 
fuppofe it is produced by the poifon of lead. 

With 



t2 MEDICAL ADMONITIONS. 

With extreme pain, fever, and vomiting, fliow m 

jiammation of the bowels- 

The fymptoms juft enumerated, may be produced 
by a protrufion of fome part of the bowels, at a 
hernia or rupture. 

Often found with weak organs of digeftion. 

COUGH. 

Long continuing ihould excite apprehenfions, left 
fome dangerous alteration be taking place in the 
lungs. 

With fhortnefs of breath, fever, and pain in the 
cheft, the face fwelled and of a purplilh colour, 
particularly point out inflammation of the lungs. 

Continuing with fhortnefs of breath, after the other 
fymptoms have fubfided, gives reafon to appre- 
hend fuch a change in the fta'te of the lungs, as 
may terminate in Confumption. 

Frequent, with increafed difcharge from the 
mouth, nofe and eyes, diftinguimes Catarrh. 

And rednefs of the eyes, accompanying an erup- 
tion on the fkin, with fever, are the fymptoms 
oiMeqJles. 

May fometimes be an hyfterical affection. 

Is 



MEDICAL ADMONITIONS. 13 

Is fometimes fymptomatic of an affedion cf the liver. 

Difcharging purulent matter, and accompanied by 
fever, increafmg twice in the twenty-four hours, 
mows that Confumption has taken place. 

Strangulating, convulflve, quickly repeated, and 
accompanied with a peculiar hooping found, 

Uooping Cough. 

CRAMP IN THE LEGS. ' 

A frequent fymptom in the difordef of the bowels, 
termed the Cholera Morbus. 

DEAFNESS. 
Succeeding to a purulent difcharge from the ear, 
is feldom cured. 

Of confiderable length of duration, often depends 
on the external paffage of the ear being ob- 
ilrufted by wax, and confequently may be cured 
by its removal. 

DELIRIUM. 

Preceded by cold fhivering, and fucceeding to ex- 
ceffive indulgence in fpirituous liquors, demands 
the utmoft attention, iince inflammation of the brain 
may perhaps be forming. 

In acute difeafes, never occurs without danger. 

In 



14 MEDICAL ADMONITIONS. 

In the beginning of fever, ought to excite the ut. 
. moft alarm, it probably being the confequence 
of inflammation of the brain. 

Accompanying Eyflpelas, or St. Anthony's Fire, and 
increafing as the difcafe proceeds, is an alarming 
fymptom ; pointing out fome ferious affection 
of the brain or its membranes. 

Whenever violent, with rednefs of the face and 
eyes, and fever, the patient experiencing great 
inconvenience from light and noife, inflammation 
of the brain may be concluded to be prefent. 

DROPSICAL SWELLING, 
Of the whole body, at the conclufion of Scarlet Fe- 
ver, fliews a dangerous difpofition, and if not 
. removed at it's firft appearance may terminate 
fatally. 

DROWSINESS, 
With a difficulty of fpeech and of recollection, and 
numbnefs of the limbs, demand the greateft at- 
tention, being often the fore-runners of Palfy or 
Apoplexy. 

Accompanied by pain in the head and pit of the 
ftomach, and preceded by ftiivering, fometimes 
takes place on the commencement of the fever 
of Small Pox. y 

With 



MEDICAL ADMONITIONS. 1 5 

With a frequent dry, hoarfe cough, and running 
at the eyes and nofe, is generally followed by the 
eruption of the Meajles. 

EARS, 
Extreme pain of, always to be confidered as a 
fymptom demanding great attention ; Jfince it 
generally ihows inflammation to have taken 
place, which, if not removed in time, may ter- 
minate in deafnefs for ]ife. 

Senfe of linging in, with head-ach and continual 
drowfinefs, threatens Palfy or Apoplexy. 

ERUCTATIONS, 

Frequent acid, denote a weaknefs of the Jlomach. 

ERUPTION, SCARLET. 

Gives name to the Scarlet Fever ; with which is fre- 
quently found ulcerated Throat.. 

Is alfoj generally, a fymptom in the malignant ulcer- 
ated Sore Throat. 

OF PIMPLES, 
In their firft appearance fomewhat refembling the 
foregoing eruption, but the cuticle being a little 
elevated, and the eruption more cluttered, marks 
it to be the Meajles. The making the neceflary 
diftin&ion is more eafily accomplifhed, when the 
eyes and noftrils fufFer an increafe of difcharge? 

and the former look red and inflamed. 

When 



1 6' MEDICAL ADMONITIONS. 

When more diftincT: and more elevated, and the 
noftrils and eyes are not affected, as in the for- 
mer cafe, the difeafe may be concluded to be the 
Small Pox, which will foon plainly appear, the 
eruption afluming a puftular form. It mould 
be remembered that the termination of this and 
the former difeafe, will frequently depend on 
their treatment in their firft ftages. 

If it refembles the eruption juft mentioned, except 
in its afluming, at its firft appearance, more of 
a veficular form, and dying off on the third or 
fourth day, the difeafe is the Swine or Chicken 
Pox ; a difeafe without danger, and feldom de- 
manding medicinal afliftance. 

VESICULAR, 
Appears of the fize of a millet feed in fevers, and 
other difeafes, where there has been profufe 
fweating, or in cafes where much blood has been 
loft ; and is termed the Miliary Eruption. 

OF RED SPOTS, 
With a lighter centre, accompanied with an itch- 
ing, refembling that which is produced by the 
flinging of nettles, is called the Nettle Rajh. 

Scaly, white, and itching, beginning about the 
elbows, and fpreading to the hands, the body 
and face, is the Leprofy. 

OF 



MEDICAL ADMONITIONS. I J 

OF SMALL PIMPLES, 
Containing a pellucid fluid, appearing all over the 
body, but chiefly at the bending of the limbs, 
and itching violently, is the Itch. 

On the head, terminating in ulcers, which dif- 
charge a humour foon drying into a whitifh 
cruft, is denominated Tinea, or Scald Head. 

EXTREMITIES 
Becoming cold, in acute difeafes, marks danger. 

Becoming cold, with pain in the belly, or with 
great heat of the body, alfo fhews danger. 

EYES, . 

Not doling during ileep, in fevers, is a bad fymp« 
torn. 

Red, painful, and watery, with incapability of 
fuftaining the light, fhows inflammation of this 
organ. 

Appearing funk, dull, or watery, is a fymptom of 
much danger in fevers. 
'■ 

FACE 
Contracted, the eyes appearing funk, nofe fliarp, 
the ears cold, the fkin dry and pale, the eye lids, 
lips, and cheeks livid, mow life to be nearly at 

an end. 

Swelled^ 

C 



1 8 MEDICAL ADMONITIONS. 

Swelled, pale, and of a waxy hue, in children, 
points out a difpofition to Rickets. 

Pale and fallow in young female fubjects, 



mows fuch a cacheclic difpo/ition, as if not remov- 
ed may terminate in complaints of a very ferious 
tendency. 

FAINTING. 
When it occurs frequently, points out a very de* 
bilitated ft ate of the fyftem. 

FEVER, 

Accompanying pain in any internal part, mows in 
general, that inflammation is eftablifhing itfelf in 
that part ; and can only be removed by an im- 
mediate employment of powerful means. 

Incrcafing about noon and evening, with fweats 
during the latter part of the night ; and the u- 
rine depofiting a bran-like fediment, gives reafon 
to fuppofe that fome change in the fyftem, full 
of danger, has taken place. 

FITS, 
Happening juft before the eruption of the Small- 
pox, are not always, though generally fucceeded 
by a favourable kind. 

GIDDINESS, 
With ficknefs of the ftomach and lofs of appetite, 
Ihows the Stomad to be foul. » Ac- 



MEDICAL ADMONITIONS. 19 

Accompanied with head-ach, finging in the ears, 
and impaired powers of recollection, threatens 
apoplectic or paralytic attacks. 

HANDS and FEET Swelling 
IN SMALLPOX. 
As the fwelling of the head and face fublides, is a 
favourable fymptom. 

HEAD - ACH. 
Continuing, with violence, through the courfe of 
fevers, fhews that a fatal termination of. the fever 
is to be apprehended. 

With giddinefs, ficknefs, and lofs of appetite, but 
without fever, accompanies foulnefs of the Stomach. 

With rednefs of the face and eyes, and fever, are 
fymptoms of inflammation of the brain. 

Accompanying Inflammation of the Eyes, is in gene- 
ral a mark of danger. 

With eructations, and lofs of appetite, points out 

lndigejlion. 

With pain and tenfion at the pit of the ftomach, 
generally proceeds from wind pent in the ftom- 
. ach. 

When accompanied by a firicl Jiate of the bowels, 
may be attributed to that circumftance* 

With 



20 MEDICAL ADMONITIONS. 

With florid countenance, and a full, fluggifli pulfe, 
may arife from fullnefs of blood. 

With chillinefs, flight fhiverings,and great latitude, 
generally diftinguifh the commencement of fever. 

HEAT 
At the pit of the ftomach and four rifings, confti- 
tute the Heart-burn^ arifmg from Weaknefs of the 
ftomach. 

May not, in putrid fevers^ arrive at fuch a degree 
as to excite a neceflary degree of alarm, in the 
friends of the patient. 

With pain in any external part, gives reafon to 
fufpect inflammation to be proceeding \o fuppura- 
iion. 

Internal, with cold limbs, in fevers, points out 
great danger. 

HICCUP, 

Succeeding to confiderable evacuations, fliows much 
danger. 

Occurring in the progrefs of internal inflamma- 
tion, gives reafon to fear the coming on of Mor- 
tification. 

Is an alarming fymptom in cafes of Suppreffion of 

Urine. 

Shows 



MEDICAL ADMONITIONS. 21 

Shows great danger to exift in cafes of Jlrangulated 

rupture. 

Generally found to accompany eruptive fever of 
meafles. 

LASSITUDE, 
And real debility, generally precede the other 
fymptoms of fever. 

And languor, in children, mould always excite vi- 
gilance in parents and thofe who have the care 
of children. 

LEGS, SWELLING OF, 

In a very flight degree, in perfons rather advanced 
in years, and uiing but little exercife, is not to 
be regarded as an alarming circumflance. 

In perfons beyond the middle ftage of life, who 
are afTe&ed by difficulty of breathing, may be 
confidered as entirely depending on the diford» 
ered iiate of the lungs ; and as pointing out the 
neceffity of exertions being made for their relief, 

With diminution of urine, and failure of ftrength, 
fhould be coniidered as a warning that fome 
important change in the fyftem is taking place, 
perhaps tending to Dropjy. 

LIPS, 



22 MEDICAL ADMONITIONS. 

LIPS. 
Eruptions on, fucceeded by fcabs, in fevers, is a fa* 
vourable fymptom. 

LOOSENESS, 
Occurring in cafes of hectic fever, with night 
fweats, mows danger. 

MATTER, 

Difcharged from the lungs, hectic fever being alio 
prefent, a mark of confumption. 

Of a purulent appearance may be difcharged from 
the lungs, and if without hectic fever, confump- 
tion may not fucceed, if very powerful means 
are employed. 

MENSES, 
When fuppreffed in confumption no benefit will 
be derived from endeavouring to procure their 
return ; their fuppreffion being a fymptom, not 
the caufe of confumption. 

MIND, 
Much dejected in the beginning of fevers, gene- 
rally points out a confiderable degree of malig- 
nancy in their nature. 

PAIN, 
Internal, with fever, requires particular attention ; 
it in general denoting inflammation of fome inter- 
nal part. 

Suddenly 



MEDICAL ADMONITIONS. 23 

Suddenly ceafing, in cafes of internal inflammation, 
the countenance finking, the pulfe becoming 
very quick and fmall, with frequent cold fhiver- 
ings, gives caufe to fear the coming on of morti- 
fication. 

In cafes of internal inflammation, gradually dimin- 
ifhing, and a fenfation of weight in the part 
gradually arifing, with fome degree of anxiety, 
fhews that fuppuration is taking place. 

IN THE HEAD, 
With fever, rednefs of the face and eyes, and ina- 
bility to bear noife and light, are fymptoms of 
inflammation of the brain or its membranes. 

IN THE EAR, - 
With feveriflinefs, fymptoms of inflammation in the 
ear. 

IN THE CHEST, 
With a fenfe of oppreffion, and of heat under ths 
breaft bone, with a falttfh tafte in the mouth, 
generally precedes /pitting of blood. 

In the cheft, with fever, difficulty and fhortnefs of 
breathing, are marks of inflammation of the lungs. 
If the other fymptoms here enumerated are pre- 
fent, the difeafe may be concluded to exift, al- 
though the pain be not confiderable. 

ACROSS 



24 MEDICAL ADMONITIONS. 

ACROSS THE CHEST. 
Coming on fuddenly, during walking, and parti- 
cularly whilft going up {lairs, or afcending a hill ; 
a pain alfo being felt, at the fame time, about 
the middle of the arm, are fymptoms of the dif- 
eafe termed Angina Pecloris. 

PAIN OF THE SIDE, 
Increafed by drawing in the breath, and particu- 
larly by coughing, with hard pulfe, and diffi- 
culty of laying on the pained fide, denotes Pleurify 
or Inflammation of the Pleura or membrane invert- 
ing the infide of the cheft. 

IN THE LEFT SIDE OF THE CHEST, 
With fever, great anxiety, irregular pulfe, faint- 
ing} and palpitations, are fymptoms of inflamma- 
tion of the heart. 

IN THE LEFT SIDE, 
Under the ftiort ribs, with fulnefs and tenfion, dif- 
tinguiihes the inflammation ofthefpken. 

ON EITHER SIDE OF THE CHEST, 
Not very acute, nor violently increafed during in- 
fpiration, may occur in confequence of an affec- 
tion of the mufcles of the cheft. 

IN THE RIGHT SIDE, 

Under the fhort ribs, extending to the moulder, 

with fever, points out inflammation of the liver. 

OVER 



MEDIC A& -ADMONITIONS. 25 

OVER THE WHOLE BELLY, 
Increafed by ftraitening the body, extreme forenefs 
and fever, mark inflammation of the peritoneum, or 
membrane lining the cavity of the belly* 

Very violent vomitings, obftinate eoftivenefs and 
fever, diftinguifh inflammation of the bowels. 

ABOUT THE NAVEL, 
Very fevere, with eoftivenefs and contraction of 
the belly, are fymptoms of Colic. 

With frequent flimy ftools, ftreaked with blood, 
point out Dyfeniery or Bloody Flux. 

AT THE BOTTOM OF THE BELLY, 
With fulnefs and extreme tendernefs on preffure, 
and frequent painful attempts to pafs urine* 
which efcapes only in fmall quantities, mows 
, inflammation to have poflefTed the bladder, 

IN THE BACK, 
One of the firft fymptoms of fever, and generally 
occurs to a great degree in malignant and in erup- 
tive fevers. 

IN THE LOINS, 
Palling forwards toward the bottom of the belly s 
fever, vomitings, numbnefs of the thigh, and 
drawing up or pain of the tefticles in the afFe&ed 
fide, accompany inflammation of the kidneys. 

D IN 



26 MEDICAL ADMONITIONS. 

IN THE LARGE MUSCLES, AND IN THE JOINTS', 
Without rednefs, fwelling, or fever, occurs in 

Chronic Rheumatifnu 

With fwelling, rednefs, and fever, diftinguifh acute 
or Inflammatory Rheumatifm. 

IN THE SHIN BONES, 
Or in the head, fuffering a confiderable augmenta- 
tion in the evening, demands immediate atten- 
tion. 

IN THE JOINTS OF THE GREAT TOE, 
Inftep, or hand, generally preceded by fome affec- 
tion of the ftomach, and coming on moft com- 
monly in the night, characterizes the attacks of 

Goat* 

IN THE LIMBS, 
Generally occurs at the commencement of fever. 

AT THE PIT OF THE STOMACH, 
With vomitings, may proceed from Gallstones. 

At the commencement of fever, is often followed 
by a difeafe of a confiderable degree of malignity. 

Alfo frequently precedes the eruption of the Small 
Pox or Meafles. 

And heat in the ftomach, increafed by the fwal- 
lowing of even fluids, with vomitings, extreme 
anxiety, and fever, with are fymptoms of inflam- 
mation of the ftomach, AT 



MEDICAL ADMONITIONS. , iy 

AT THE BOTTOM OF THE BELLY, 
With heat, fwelling, and tendernefs on preffure, 
frequent vomitings and fever, are fymptoms of 
inflammation of. the womb. Darting, in the region 
of the womb, generally accompanies a fchirrous 
4r a cancerous Jiate* 

PALPITATION OF THE HEART, 

May proceed from fome difeafe, originating in the 
heart itfelf j or may be fymptomatic of general 
debility. 

With quick and difficult breathing, after moderate 
exercife, and fallownefs of the complexion, marks 
of chlorofis. 

Irregular pulfe, extreme anxiety, and frequent fits 
of fuffocation, generally accompany Dropfyofthe 

Pericardium, 

PAROXYSM, FEBRILE, 
Returning repeatedly, after twenty-four hours in-, 
termiffion, diftinguiflies the Quotidian Ague. 

Returning after an intermiffion of forty-eight 
hours, the Tertian Ague ; 

And, after an intermiffion of feventy-two hours, 

the Quartan Ague. 

PULSE 



28 MEDICAL ADMONITIONS. 

PULSE 
Quick, fucceeding to cold fhivering, and accompa- 
nied by heat, ihows the exiftence of fever. 

Quick, hard and ftrong, with preternatural heat, 
points out inflammatory fever. 

Similar to the foregoing accompanies particular in- 
flammation. 

Hard, fmall and quick, is generally found with 
inflammation ofthejiomach or bowels. 

Quick, fmall and weak, with extreme debility in 
fevers, mows the fever to be malignant, and 
great danger to exift. 

REDNESS OF THE SKIN. 
Diffufed, hot and but little fwelled, the Ikin only 
elevated as with a little roughnefs, diftinguifhes 
the Eryflpelas, or St. Anthony's Fire. 

OF THE CHEEKS, 
Coming on with the he&ic fever, marks Confump- 
tion. 

RESPIRATION QUICK AND SHORT. 
With fever, and tightnefs acrofs the cheft, indi- 
cates inflammation of the lungs. 

SHORT AND QUICK, 
Pains in the fide of the cheft and fever, diftinguifh 
Pleurify. DIFFICULT, 



MEDICAL ADMONITIONS. 29 

DIFFICULT, 
Recurring by fits, without fever generally marks 

Ajlhma. 

Awaking the patient with confiderable alarm, with 
weight acrofs the cheft, and fwelling of the feet s 

points out water in the cheji. 

May alfo accompany Inflammation of the Liver, 
various affections of the heart and large velfels, 
diftenfion of the bowels by wind, and the pre- 
ternatural enlargement of any of the bowels. 

RESPIRATION. 
Snoring and long, with the appearance of deep 
fleep, diftinguifhes Apoplexy. 

DIFFICULT, 
A bad fymptom, in all fevers. 

RIGIDITY, 
At the fide of the face, and back of the neck, and 
difficulty of fwallowing, are the firft- fymptoms 
of a Locked Jaw. 

SHIVERING, 
Is the firft fymptom of every febrile or inflammatory 
difeafe. 

In fevers, not fucceeded by increafe of heat and 
fweat, an unfavourable fymptom. 

Occurring 



g© MEDICAL ADMONITIONS. 

Occurring in the latter ftages of fever, the patient 
being very low and weak, is alfo an unfavoura- 
ble fign. 

r 

With delirium, following intoxication, threatens a 
dangerous affection of the brain. 

After violent inflammation, fhows that fuppuration 
is taking place. 

In the fmall-pox, about the ninth day, the fkin ap- 
pearing fhrunk, and the puftules flattening, and 
becoming pale at their bafes, fhows danger. 

SICKNESS 
Occurring after having been in the chamber of a 
perfon in a fever, fometimes marks the firft im- 
preflion of infection, requiring the immediate 
employment of an emetic. 

Accompanied with pain at the ftomach, heartburn, 
and lofs of appetite, fhows the weaknefs of the 
ftomach. 

SIGHING 
Frequent, in fevers, a bad fymptom. 

SIGHT, EXTREMELY INDISTINCT, 

In fevers, the patient being much exhaufted, fhows 
much danger. 

INDISTINCT. 



MEBICAL ADMONITIONS. 3 ; j[ 

INDISTINCT. 
The eyes becoming uneafy and hot, after reading, 
&c. the eye requiring to be removed farther 
for the examination of any minute object than 
it* has been wont, mows the convexity of the 
cornea' to have become morbidly difeafed, and 
that the ufe of convex glaffes is pofitiveiy indi- 
cated # . 

Affe&ed by dark fpots and ftreaks- appearing on 
the objefts viewed, fhows a ferious affection 
of the eyes, but this is not, as has been fuppofecf, 
a fign that blindnefs mull inevitably follow, fince 
this affe&ion may fometimes be removed by pro= 
per meamres. 

SKIN, COLD, 
Whilft great thirft and internal heat are experi- 
enced, is a bad fymptom in a feven 

PUNGENTLY 

* In a publication of this kind, it would be worfe than 
folly to facrifice utility to a fcrupulous adheience to order ; the 
above indication is therefore introduced, although rather out of 
place, from a conviction, that through inattention to this circum- 
stance, the eyes are often confiderably injured. Objects require 
painful exertion to obferve them diftinctly ; this being frequently 
done, the organs of vifion are drained, and all the range of eye- 
waters employed, when the cure is only to be found in the ufe of 
a pair of fpe&acles, 



32 MEDICAL ADMONITIONS. 

PUNGENTLY HOT, 
Leaving a fmarting fenfation of heat on the fingers 
of the examiner, fliows great malignancy in fever. 

OF A GREENISH YELLOW. 
Gives name to the Green Sicknefs. 

YELLOW, 
As well as the urine and the whites of the eyes, 
and the ftools white, diftinguiflies Jaundice. 

SLEEP 
Returning, with appetite for food, may be confid- 
ered as a moft favourable fymptom in every fever. 

Calm, after delirium, is a favourable event. 

SLEEPINESS 
Often precedes and accompanies the Eryfipelas of 
the face ; and if it increafes with the difeafe, it 
points out much danger. 

SNEEZING, 
Difcharge of a limpid fluid from the eyes and 
nofe, and frequent cough, mow that Catarrh 
and Coryza, as it is termed, are forming. 

SPIRITS 
DEPRESSED IN THE BEGINNING OF FEVERS, 
Shows the fever to be of a low and malignant 
kind, 

DEPRESSED 



MEDICAL ADMONITIONS. 33 

DEPRESSED WITHOUT CAUSE, 

Lofs of appetite, ficknefs, pain, and oppreflion in 

the ftomach, diftinguifh hypocondrlacal affeclions. 

SPITTING, 

Bifcoloured with blood, raifed by coughing, fhows 
fuch a ftate of the lungs as requires the greateft 
care and attention. 

SPOTS 

LIVID, 
Accompanied with putrid and bleeding gums, and 
great weaknefs, are the ligns of Scurvy. 

PURPLE, 
A fymptom marking great danger in malignant 

fever. 

. STOMACH, 
Pain of, may proceed from ulcers or worms. 

VIOLENT PAIN OF, 
With vomiting and fever, are fymptoms of inflam- 
mation ofthejiomacb. 

PAIN AT THE PIT OF, 
With ficknefs, recurring at uncertain periods, and 
fucceeded by flight yellownefs of the Ikin, accom- 
panies the paffing of gall flones. 

Painful diftention of, after even moderate eating, 

generally proceeds from weaknefs of the ftom- 

ach. 

E STOOLS 



34 MEDICAL ADMONITIONS. 

STOOLS 

WHITE, 

Shew an obftru&ion of the gall through the' duels; 

hence alfo yellownefs of the fkin, or 'Jaundice. 

BLACK, 
With fudden relief from violent pain in inflamma- 
tlon of the bowels, mow great danger. 

SLIMY, 
Sometimes bloody, and griping pains, are fymp- 
toms of Dyfentery, or Bloody Flux. 

STUPOR, 

After wounds, or blows on the head, requires par- 
ticular attention. 

SWALLOWING 

DIFFICULT, 
And acutely painful, with fwelling and rednefs of 
the back of the mouth or upper part of the 
throat with fever, marks inflammatory fore Throat. 

And not extremely painful, white crufts or floughs 
forming in the upper part of the throat, and a 
low fever, point out, efpecially if a fcarlet erup- 
tion appears on the breaft, arms, &c. that the 
fore Throat is of the ulcerated malignant kind. 

Coming on gradually, and without pain or fever 
gives reafon to fear a contraction is taking place 

in 



MEDICAL ADMONITIONS. 35 

in the gullet. Endeavours for it's cure are only 
to be made with a profpect of fuccefs during the 
commencement of the difeafe. 

Of liquids, inability of, and dread of water, confti- 
tute the difeafe termed Hydrophobia. 

Of liquids, fometimes impeded in cafes that are 
plainly Hyjierkal. 

SWEAT, 
GENERAL AND PROFUSE, 
Occurring in cafes of inflammation, a favourable 
fymptom. 

PROFUSE, 
Succeeding to hectic heat, with difficulty of breath- 
ing, cough, and fpitting of purulent matter, dif- 
tinguifh confumption, 

BREAKING OUT GRADUALLY, 
And continuing fome time, is, in general, a favour- 
able fymptom in fevers. 

Almoft always concludes the fit of Ague. 

COLD, 

Breaking out about the face and neck in fevers^ 
ihows great weaknefs and danger. 

SWELLING 
OF THE HEAD AND FACE, 
Takes place, in fmall-pox, according to the number 
and confluency of the puftules. Ac- 



36 MEDICAL ADMONITIONS. 

Accompanies and fucceeds Eryjipelas, or St. Antho- 
ny's Fire in the face. 

OF THE HANDS AND FEET, 
In Small-Pox, fucceeds, to the fwelling of the head 
zndface. 

ABOUT THE ANGLES OF THE JAW, 
With flight fever, diftinguifhes the Mumps. 

OF THE HEAD, 
In young children, who are heavy, drowfy, and 
even at times convulfed, gives reafon to fear 
Dropfy of the Brain. 

OF THE FORE PART OF THE HEAD, 
Large belly, the reft of the body thin, and the 
joints enlarged, are fymptoms of the Rickets. 

OF THE UPPER PART OF THE RIGHT SIDE OF 

THE BELLY, 
Gives reafon to apprehend Enlargement of the Liver. 

OF THE BELLY, 
Elaftic and fonorous, on being ftruck by the fin ? 
gers, diftinguifhes the Tympany. 

The ftroke of the fingers producing a difcoverable 
fluctuation, diftinguifhes the A/cites, or the col- 
lection of water in the cavity of the Belly. 

AT 



MEDICAL ADMONITIONS. ' tf 

AT THE BOTTOM OF THE BELLY, 
With fuppreffion of urine, or frequent inclination 
to void it, with pain, tendernefs, or prelfure, 
characterize Inflammation of Urine. 

OF THE SCROTUM, 
Painful and hard, fhows inflammation of the part. 

Not painful, rather pellucid, and giving the idea of 
fluctuation on being gently ftruck with the fin- 
ger, diftinguifhes Hydrocele, or Dropfy of the Tef- 

ticle. 

Gradually increafing downards, and enlarging 
upon fneezing or coughing, mows Hernia, or 
protrufion of fome part of the bowels. 

OF THE FEET AND HANDS, 
In Small-Pox, generally takes place as the fweiiing 
of the face fubiides. 

OF THE FEET, 
Where confiderable difcharge of blood has taken place, 
Ihows that a dangerous degree of debility is 
brought on. 

Is, in general, a fymptom demanding particular 
attention. 

OF ANY PART, 
With heat, rednefs, tenfe'nefs and throbbing, fhows 
an Abfcefs to be forming in that part. 

Cold 



38 MEDICAL ADMONITIONS. 

Cold, pallid, and retaining the impreflion of the 
fingers, diftinguifhes oedematous fwellings. 

IN THE BREAST, 
Solid, the edges rather hard and not very painful, 
is moft probably, fchirrous tumour •, which, unlefs 
removed, will terminate in Cancer. 

OF THE GLANDS 
In the fides of the neck, with fwelling and chap- 
ping of the lip, and large belly, ihow a fcrophu- 
lous difpofition. 

TASTE, 

BITTER, 
Sicknefs, want of appetite, and pain at the ftomach, 
are fymptoms of indigeftion and iveaknefs of the 
ftomach. - 

ACID, 
With the foregoing fymptoms, alfo occurs in weak- 
nefs of the ftomach. 

TEETH, 
GRINDING OF, 
In fever, a fymptom of danger. 

In children, a fymptom of worms. 

ACHING OF, 
A fymptom of inflammation, or Caries. 

Covered 



MEDICAL ADMONITIONS. 39 

Covered with dark, foul, vifcous matter, in fevers, 
generally marks malignancy. 

TENDONS. 

Twitching, at the wrift, in fevers, fhows danger. 

TESTICLES 
SWELLED, 
Occurs fometimes at the clofe of the difeafe called 
the Mumps. 

DRAWN UP, 
And affected with aching pain, with pain in the 
back, ftretching forwards and downwards, with 
ficknefs at the ftomach, are fymptoms of gravel 
in the kidneys, or ureters, 

THIRST 
Generally prefent in fever. 

Frequently occurs in fever ; but, when wanting, 
where the tongue is parched and foul, fliows 
danger. 

Is generally a troublefome fymptom in Dropfy* 

THROAT, 
SWELLED AND RED, 
Swallowing very painful, mark the inflammatory 
Sore Throat, 

OF 



40 MEDICAL ADMONITIONS. 

OF A DEEP CRIMSON COLOUR, 
With whitifh fpecks, fpreading and deepening ; 
extreme debility, and the pulfe fmall and quick, 
diftinguifh the putrid ulcerated Sore Throat. 

THRUSH, OR APHTHA, 
Little ulcers, generally white, appearing on the 
tongue, infide of the lips, cheeks, &c. 

When thefe occur to children, it may in general 
be concluded either that the food of the child is 
not fufficiently nutritious, or that the child 
breathes an air too impure. 

Frequently appear in the latter ft age of confumption. 

Appearing in fever, not always to be confidered as 
a fymptom of extreme danger, but fometimes as 
a mark of a critical, and even favourable change 
having taken place. 

TONGUE, 
TREMBLING AND BLACK, 
A fymptom of danger in fever. 

Parched, without thirft, in fevers, is a bad fymp- 
tom. 

HARD TUMOUR OF, 
Though fmall, demands immediate care. 



TOSSING ABOUT, 
A frequent fymptom in dangerous fever 



TREMOR, 



MEDICAL ADMONITIONS* 4* 

TREMOR, 

In fever, a fign of great debility. 

VOMITING, • 
Frequently fymptomatic of inflammation of the 
kidney, and is generally excited by the palling 
of gravel. 

Very frequent, extreme pain in the ftomach, fever, 
and fmall hard pulfe, diftinguilh Inflammation of 
the Stomach* 

With great pain in the bowels, fever, obftinate cof- 
tivenefs, and hard and fmall pulfe, point out in- 
flammation of the bowels and Jirangulated rupture. 

After blows or wounds on the head, gives reafon 
to fufped: very ferious injury. 

BILIOUS; 
With frequent bilious ftools and pains in the bow- 
els, are the fymptoms of the difeafe termed Cho- 
lera Morbus* 

URINE; 
DEPOSITING A BRANNY RED SEDIMENT, 
And the foles of the feet and palms of the hands 
frequently difagreeably hot, fliow he&ic fever to 
be prefeut. 

E BLOODY, 



42 MEDICAL ADMONITIONS. 

BLOODY, 
Shows a rupture, or morbid dilutation of fomc 
blood veffel, in the kidneys, bladder, or urinary 
paffage. 

WITH A CREAM-COLOURED SEDIMENT, 
Blended with fmall light-coloured flakes, mark the 

exiftence of an Ulcer in the bladder* 

\ 

HIGH-COLOURED, 
Generally accompanies inflammation, and inflamma- 
tory/ever. 

HIGH-COLOURED, 
Depofiting a fediment of a pink, or of a brick-duft 
colour, generally fhows difeafe of the liver. 

IN THE COLD STAGE OF AGUES, 
Generally limpid, in the hot Jlage high-coloured 
and clear, and, during the abfence of the fever, 
depofiting a reddifh fediment. 

WITH AN OILY SKIN 
On the furface, points out a dangerous wafting. 

PASSING IN EXCESSIVE QUANTITY, 
Proceeds from Diabetes. 

COPIOUS AND VERY LIMPID, 
But of a natural colour and quantity at intervals, 
generally accompanies nervous affections. 

May 



MEDICAL ADMONITIONS. 43 

SUPPRESSION OF, 
May occur as a fymptom of inflammation of the 
kidneys, ureters, bladder, or of the urethra, or 
urinary paffage ; it may alfo be occafioned by a 
paralytic affection of thefe parts and by ftridures 
in the urethra. 

Paffed without the patient's knowledge in fevers 
is a bad fymptom. 

WAKEFULNESS, 

Long continued, in fevers, with great eagernefs 

of attention., denotes the approach of Delirium. 

WEAKNESS, 
And indifpofition to motion, a fymptom of Ckloro- 
Jis or Green Sicknefs. 

Extreme, at the beginning of fevers, generally 
marks malignity. 

YAWNING, 
Generally occurs at the commencement of the 
ague fit. 



Medical Admonitions. 



MY DEAR FRIEND, 

I COMPLY, with the utmoft willingnefs, with 
your requeft to fupply you with fuch information 
as may prevent you, on the one hand, from unne- 
ceffarily incurring the expence of medical attend- 
ance in the various trifling ails to which you and 
your family may be fubjecled ; and, on the other, 
from facrificing a friend, or perhaps a beloved child, 
by delay or improper interference, in fosne infi- 
dious difeafe. 

I undertake the work with additional pleafure, 
derived from the flattering confideration that I 
may, by its publication, render an effential fervice 
to thofe, who like yourfelf, being furrounded with 
large families, are anxious to avoid unneceffary 
expence : but are, at the fame time, aware of the 
high degree of guilt which accompanies the omit- 
ting to obtain all that is in their power to mitigate" 
the fufFerings, or to fave the life of a fellow-creature. 

I fhall not endeavour to furnifh you with in- 
ftru&ions for the cure of difeafes in general. This 
has indeed been induflrioufly attempted by feveral 

ingenious 



46 MEDICAL ADMONITIONS. 

ingenious writers on Domeftic Medicine, but cer- 
tainly not with thofe beneficial confequences which 
I hope their authors intended. On the contrary, 
I fear that their difciples, not aware of the fliallow- 
nefs of the knowledge thus gained, immediately 
on the appearance of difeafe, fly with confidence to 
tHeir oracles ; but, incapable of comprehending 
the various circumftances comprifed in the anfwers 
they receive, they frequently adopt the very means 
they fliould have avoided ; and thereby increafe 
the evils they were endeavouring to remove. It 
is not a loofe and vague affertion, that the direc- 
tions, given in fuch a work, are only intended for 
thofe cafes in which a phyfician cannot be eafily 
obtained, that will be •fufficient to deter a weak 
mind from obftinately confiding, even in the moft 
ferious cafes, in the knowledge derived from the 
perufal of a fpecious, concife, and apparently com- 
prehenfive method of cure. 

Directions for the cure of difeafes fhall, in this 
work, be confined to thofe in which no rifque can 
be incurred, by trailing them to the management 
of a domeftic practitioner. Such difeafes will not 
only be accurately defcribed, but the fymptoms 
will be carefully marked out which diftinguifh 
them from thofe difeafes which differ from them 
in degree of danger, and in the mode of treatment 

they 



MEDICAL ADMONITIONS. 4.7 

they require. The fymptoms of thofe difeafes in 
which the attendance of a phyiician or other medi- 
cal character, is required, will alfo be carefully 
marked-; the particular circumftances which- ren- 
der fuch further aid neceffary, will be pointed out; 
and the mifchiefs, likely to arife from improper in- 
terference, particularifed. Since the degree of vio- 
lence, duration, and danger, as well as the confe- 
quent injuries the patient may. experience, fre* 
quently depend upon the means employed in the 
firft moments of the attack in acute difeafes, and 
upon the conduct adopted on the occurrence of 
fudden and alarming circumftances in chronic dif- 
eafes ; the moll proper means to be employed on 
thefe occafions will be diftincHy laid down. The 
Utility of thefe directions miift be fufficiently evi- 
dent, as, particularly in the country, regular medi- 
cal afliftance often cannot be obtained, in thefe 
cafes of fudden emergency, with, fufficient fpeed ; 
and the diftrefs and confufion of thofe around the 
patient, will be likely to impede the due exercife 
of their judgment ; and to prevent their exertions 
being made, with that promptnefs which the iitua- 
tion of the patient may demand. 

Another important talk I fhall endeavour to per- 
form, is that of inftru&ing the attendants on the 
lick, how they may beft aid the effects of the means 

prefcribed 



48 MEDICAL ADMONITIONS. 

prefcribed by the phyfician. In vain may the moft 
appropriate remedies be prefcribed, unlefs the di- 
rections with which they are accompanied be duly 
attended to. But unfortunately, it too often hap- 
pens, that the orders of the phyfician do not ex- 
actly coincide with the opinions of thofe about the 
patient ; and whenever this happens, it is much to 
be feared, that either the directions are not com- 
plied with at all, or only to fuch an extent as by 
no means will accomplifh the purpofe intended. 
When prefumptuous nurfes, or the timid friends 
of a patient, deviate from the directions of the 
phyfician, by omitting that which he has recom* 
mended, or by adopting that which has been fug- 
gelted by fome neighboring doctrefs, the mifchiefs 
unfortunately do not flop here ; for, not chufing 
to have their folly known, they carefully conceal 
from the phyfician their departure from his direc- 
tions. Puzzled at finding the meafures, which he 
fuppofes to have been employed, have failed of ef- 
fecting thofe changes he expected ; and, unable to 
account for appearances, the confequences of means 
which have been ufed without his knowledge, the 
phyfician is himfelf prevented from forming an ac- 
curate judgment of the fituation of the patient. 

Of fuch importance is the information which is 
required under this head, that I mall not only take 

every 



^MEDICAL ADMONITIONS. 49 

every opportunity to communicate particular di- 
rections > but fliall trefpafs on your time, in this 
place, for the fake of offering to your confideration 
One or two general obfervations. Medical men 
have too frequently the opportunity of obferving, 
that whenever, from the urgency of the cafe, mea- 
fures apparently fevere are recommended, the 
fympathizing relatives, with more tendernefs than 
judgment, delay punifhing, as they term him, the 
poor fufferer, until fome trifling change arifes, 
which may afford them the fhadow of an excufe 
for omitting them entirely j and thus is the critical 
moment fuffered to flip, without employing thofe 
remedies which alone could have faved the patient. 

The tormenting reflections, which muft harrafs 
the minds of thofe, who become convinced of hav- 
ing thus facriiiced their friend or relation, muft 
exceed the powers of conception ; they not only 
fuffering regret for their lofs ; but, alfo experienc- 
ing the painful compunction, of having robbed 
the object of their affection of the only chance that 
exifted, of obtaining a refcue from "the hands of 
death. One of the firft objects of enquiry, on the 
death of a beloved friend or relative, is, whether 
the utmoft that art could do has been performed ; 
the mind feeking to obtain fome confolation, from 
the affurance that no meafures had been omitted, 
from which any advantage could have been de- 
G rived. 



50 MEDICAL ADMONITIONS. 

rived. Frequently it happens, that this enquiry is 
inftituted, with too much feverity and unfairnefs r 
by the afflicted, felf-accufing furvivors. Fear left 
they mould have imprudently oceafioned the event 
they deplore, magnifies every fufpicion j and the 
recollection of the moft trifling circumftances fixes 
the barbed fting in their mind. 

On this eifential point, therefore, I fliall think it 
neceflary frequently to dwell ; and to endeavour, 
by the arguments which each particular cafe may 
produce, to obtain that ftrict compliance with or- 
ders, without which the belt adapted medicine* 
may fail of their effects. 

In doing this another talk will arife ; that of re- 
futing thofe vulgar errors and prejudices which 
frequently occafion an injurious interference, as 
well as an equally pernicious neglect during the firft 
attack of the difeafe. By fhewing how unsup- 
ported fuch opinions are by reafen, and by pointing 
out the mifchiefs arifing from their influence, much 
benefit muft therefore arife. You will, I hope, be- 
lieve, that I entertain no wild expectation of con- 
quering the prejudices of doctreffes and of nurfes 
themfelves. No ! The object of endeavour under 
this head, is entirely to warn the friends of the 
fick, againft the delufive prophecies and counfels 
of thefe mod dangerous fibyls. 

By 



MEDICAL ADMONITIONS. 5 1 

By expofmg the evils refuking from the too fre- 
quent practice of domeftic quackery, it may be 
hoped too, that the benevolence of the rich may 
be dire&ed into more ufeful channels. At prefent 
it too frequently happens, that perfons of influence 
and property are too much difpofed, with the help 
of a family medicine cheft, and a treatife on domeftic 
medicine, to become the difpenfers of phyfic to all 
their poor neighbors ; and to believe, that they are 
thereby rendering more fervice to the community, 
than by contributing to the fupport of thofe na- 
tional benefits, public hofpitals, 

Having made thefe prefatory obfervations, I mail 
commence my promifed undertaking with a few, 
I truft ufeful, remarks on a difeafe, which, from 
the frequency with which it occurs, and from the 
danger with which it is accompanied, claims our 
frrft attention. 



FEVER. 



Fevers begin with fome degree of cold ftiiver- 
mg, to which increafed heat and quickened pulfe 
fucceed, with diminution of ftrength and interrup- 
tion and diforder of feveral fun&ions. In the pro- 
grefs of every fever may be difcovered three dif- 
ferent ftates, which are termed the cold, the hot, 

and 



52 MEDICAL ADMONITIONS. 

and the fweating ftages or fits : thefe, fucceeding 
in the order here defcribed, conftitute a paroxyfm. 
When thefe paroxyfms fucceed each other, with 
but little abatement of the fymptoms between them, 
flight tranfitory chills take the place of a cold fhiv- 
ering, and are foon fucceeded by the hot fit ; this 
continues for feveral hours, and leflens as a flight 
perfpiration comes on, but which is often very 
trifling, and fometimes, as well as the cold fit, is 
hardly perceptible. The increafe and abatement 
of the fymptoms, not being fo confiderable as dif- 
tinctly to mark the different ftages of each parox- 
fym, the difeafe appears to be one continued hot 
fit, and is therefore termed a Continued Fever. 
When, between each paroxyfm, there occurs an 
evident, but fhort abatement, or remiflion of the 
violence of the fymptoms, the difeafe is called a 
Remittent Fever. When an interval of fome 
hours occurs between each paroxyfm, in which 
there is a complete inter miflion, the difeafe is 
termed an Intermittent Fever or Ague. 

Continued Fevers are divided, according to their 
duration, into Slow or Acute ; they are again di- 
vided into Inflammatory or Nervous ; the latter 
fometimes acquiring the farther diftinclion of Pu- 
trid or Malignant. 

Intermittent 



MEDICAL ADMONITIONS. 53 

Intermittent Fevers are alfo divided, according 
to the length of the interval between each parox- 
yfm, into Quotidians, Tertians, and Quartans. 

There are other neceffary divifions of Fever, but 
thefe are the moll important, and fufficient, I hope, 
to authorife me to make the following obfervation. 

In a difeafe, which requires fuch numerous divi- 
fions to mark the differences between its feveral 
fpecies, it mull be obvious, that much lludy and 
experience mull be neceffary to enable any one to 
make a proper difcrimination ; and, as thefe dis- 
tinctions are indifpenfably neceffary to be made, 
previous to the determining on the plan of cure, 
you mull plainly fee that the cure ought only to 
be attempted by thofe, who have carefully ftudied 
the nature of the difeafe, and have diligently ob- 
ferved its feveral varieties. It mull indeed be al- 
lowed, that it is not difficult to perceive thefe dif- 
ferences, and point out thefe diilinctions, when the 
difeafe has nearly paffed through its courfe. But, 
in almoll every cafe of fever, it is neceffary that 
this dillinclion fhould be made, in an early period 
of the difeafe ; for fhould any one, who attempts 
the cure of fever, not be able, in its beginning, to 
make the neceffary difcrimination, there exifls the 
greatefl probability, that the evils he fuffers to in- 
creafe, as well as thofe which he brings on by im- 
proper 



54 MEDICAL ADMONITIONS. 

proper treatment, will be too great and too numer- 
ous to be fubdued, when the nature of the difeafe 
becomes known, and the moft proper means for 
its removal is adopted. 

.It is very eafy to lay down nice and accurate 
diftinctions between difeafes, in books, and the 
mind of the reader is often fatisfied of the eafe, 
with which he could make a practical application 
of them ; but every phyfician knows, that thefe 
difcriminations are not eafily made in the firft 
images of difeafes, but by thofe who poffefs that 
knowledge to obtain which, both ftudy and expe- 
rience are required. 

For the fake of exemplification, it is proper to 
remark, that the firft fymptoms of an acute inflam- 
matory fever, and thofe of a flow nervous fever, 
are often To fimilar as to point out, very equivo T 
cally, the difference between thefe difeafes ; fo ^hat 
little chance can exift of any one, but an experien- 
ced obferver, afcertaining the fpecies of the fever, 
until the occurrence of fuch fymptoms, as mall, not 
only ftrongly mark its peculiar nature, but may 
alfo mew that the difeafe, aggravated by delay or 
injurious treatment, requires the utmoft exertions 
of even the moft fkilful phyfician, to prevent a 
fatal termination. 

Since 



MEDICAL ADMONITIONS. $$ 

Since thefe fevers are well known to arife from 
two different, nay, contrary ftates of the fyftem, 
their indications of cure muft therefore be onpofite 35 
it mull be obvious, that the adopting of the treat- 
ment adapted to the one, in the endeavour to re- 
move the other, mull be likely to be fuceeeded by 
very injurious confequenees ; and yet, from what 
has preceded, it is very evident, that this miftake 
is very liable to be made by thofe domeftic practi- 
tioners, who undertake the cure of fever, without 
a fufpicion of their own incapacity. 

The difference which takes place in fevers from 
the change of feafons, and the nature of the reign- 
ing epidemic, ought to be enquired into previoufly 
to inftituting a plan of cure : fince, from thefe 
circumftances, a confiderable difference may be oc- 
calioned, in the nature of the difeafe, and confe- 
quently in its mode of cure. But, from this infor- 
mation, the domeftic practitioner mull generally be 
precluded ; it being, of courfe, confined to thofe ? 
whofe profeflion gives them the opportunity of 
remarking the progrefs of the difeafe, in many dif- 
ferent fubjects. 

The fmall-pox, meafles, and other eruptive dif- 
eafes, as well as feveral diforders which differ very 
much in their refpeclive natures, do yet agree in 
this particular, that their firft appearance very ex« 

acllr 



56 MEDICAL ADMONITIONS. 

actty refembles that of fimple fever ; and they of- 
ten, even for the firft two or three days, are with- 
out any particular fymptom, by which their pecu- 
liar nature can be afcertained, unlefs by thofe, who 
are informed of the nature of the prevailing epi- 
demic ; and are well acquainted with thofe parti- 
cular fymptoms, which are the threatening precur- 
fors of thefe feveral difeafes. The mifchievous ef- 
fects which muft arife from the interference of the 
ignorant, in thefe cafes, muft be fo obvious, as not 
to require to be here particularifed. 



INTERMITTENT FEVERS 

O R 

AGUES. 

Intermittent Fevers are compofed of feveral 
diftincl paroxyfms, in general, returning with a 
ihivering, having an evident intermiflion between 
each paroxyfm. 

The ague begins its attacks with inducing a con- 
liderable degree of weaknefs and laflitude, with fre- 
quent ftretching and yawning ; foon after a fenfa- 
tion of cold is felt in the back and extremities, 
which foon pervades the whole body ; this increa- 
fes, until the limbs, as well as the trunk of the bo- 
dy, become agitated with frequent violent fhiver- 

lBgS. 



MEDICAL ADMONITIONS. §f 

ings. This ftate continues fome timCj during 
which a violent pain of the back and head^ and, a 
fenfation refembling a ftri&ure acrofs the ftomach^ 
frequently diftrefs the patient ; and the fenfe of 
coldnefs becomes fo great, that no endeavours to 
obtain warmth are of the leaft avail ; the agitation 
of the whole frame being alfo, fometimes, fo vio- 
lent, that the patient is with difficulty held in his 
chair j the pulfe becomes fmall and frequent ; thg 
breathing, oppreffed ; and the urine, clear and al- 
moft colourlefs. Thefe are the principal fymptoms 
.which diftinguifh the Cold Fit, 

Thefe fymptoms fubfiding by degrees, give way 
to warm flufhings, which gradually increafe, until 
rednefs and heat, much greater than natural, is ex^ 
tended over the whole body ; the patient, at length, 
burning with fueh extreme heat as to be now, as 
folicitous for the refrefhing fenfation of cold, as he 
was before anxious to mitigate its violence. His 
fufferings become now increafed by an almofHn- 
fatiable thirfl, and a pain of the head, fometimes 
ending in delirium, and fometimes bringing on a 
lethargic and almoft apoplectic ftate ; the pulfe 
becomes more hard and full ;' the refpiration, freer; 
and the urine, high coloured, but without fedi- 
ment. Thefe are the chief fymptoms obfervable 
in the Hot Fit. 

H After 



58 MEDICAL ADMONITIONS, 

After thefe complaints have exifted fome time, 
the heat gradually declines, the thirft leffens, and 
the fkin is relaxed, a fweat gently breaks out on 
the head, and gradually diftufes itfelf over the 
whole body : this increafes, until it becomes pro- 
fufe, after which it abates, and by degrees entirely 
ceafes. During this ftage, which is termed the 
Sweating Fit, the pulfe becomes flower and fofter, 
and the breathing more free ; the urine, after the 
fweat has continued fome time, depofits a fediment^ 
which is generally of a reddifh colour. 

The above ftages of the difeafe having been 
gone through, the patient enjoys an intermiffion 
of the fymptoms, which lafts according to the par- 
ticular type which the difeafe airumes. 

According to the length of time in which the 
paroxyfm returns, the ague obtains its name. If 
the paroxyfm returns every day it is termed a 
Quotidian, if every third day a Tertian, if every 
fourth day a Quartan, &c. 

The remote caufes of agues are, firft, the effluvia 
which arife from marines or moift grounds acted 
on by heat ; fecondly, cold, efpecially when accom- 
panied by moifture. Thefe will neceffarily act with 
more certainty, if a predifpofition to the difeafe 
exifls. This predifpofition may be induced by too 

fpare 



MEDICAL ADMONITIONS. 59 

fpare living, exceffive fatigue, watching, exceilive 
fludy, indulgence in crude and watery food and 
in fpirituous liquors, and by preceding difeafes ; 
particularly fuch as have been attended with large 
evacuations, in a word, by every thing which 
tends to weaken the fyftem. 

Although the fymptoms, which have been defcri- 
oed, may appear to be fufficiently characteriftic, to 
prevent agues from being miftaken for any other 
difeafe, even by a domeftic pra&itioner ; yet fuch 
an error may be very likely to take place : for in- 
termittents are often accompanied by fuch irregu- 
lar fymptoms, as render it very difficult to afcer- 
tain the real nature of the difeafe. 

The fagacious Sydenham obferves, that "It has 
"happened in every epidemical conftitution, that 
"in fome of thofe who had the fever (the inter- 
"mittent fever) the fit did not begin with chills 
"and fhivering, but the patient was attacked with 
"fymptoms refembling true apoplexy. What need 
" (he fays) of more words, for it affumes fo many 
"fhapes as to imitate almoft all the difeafes to 
"which mankind is liable ?" 

Need there be any referve then ufed, in point- 
ing out this difeafe as one of thofe, which does not 
come within the -reach of domeftic practice ; iince, 

from 



6o MEDICAL ADMONITIONS. 

from the ambiguity of its firft appearances, fuch 
miftakes may take place as may prove dangerous 
in their confequences ? Befides, fevers frequently 
occur, which, at firft, appear in a continued form j 
but in which, after a little time, certain fymptoms 
appear, pointing out, to the difcerning obferver, a 
difpofition to affume the form of an intermittent. 
In fuch cafes, the greateft fkill is required ; for on 
the mode of treatment adopted, at this period, the 
length of the difeafe, and the life of the patient, 
may depend : fince, if due care be now taken, the 
difeafe may be brought to intermit, and foon after, 
wards be entirely removed ; but, if this opportu r 
nity be loft, its violence may be increafed, and its 
duration dangeroufly protracted. 

So much danger to a patient, and alarm to his 
attendants, will fometimes be produced, by an in- 
termittent fuddenly changing into a continued 
fever, as ought to deter family practitioners from 
attempting the cure of ague. Another cafe of 
alarm and confufion, to which they will be expofed, 
is the irregularity with which the paroxyfm re- 
turns. The deviation is frequently fuch, as will 
prevent, even the moft intelligent, from directly 
determining, whether the fever is, or is not, an 
intermittent. 

After. 



MEDICAL ADMONITIONS. til 

After what has t»een already remarked, it cannot 
be expected that a full and regular plan of cure 
fhould be detailed here. Inftead of this, a general 
idea of the mode of cure fhall be given, with a few 
detached, but, it is hoped, ufeful obfervations on 
the regimen and conduct of the patient. 

The virtues of the Peruvian bark, in the cure 
pf agues, are fo univerfally known, that it may 
have the appearance of an artful cautiori, to fuggeft, 
that any difficulty or danger can arife, from the 
endeavours to obtain the cur,e of ague by its means. 
But every medical man knows, that*, with the ague, 
may exift certain States of the vifcera, which, if not- 
corrected, previoufly to administering the bark, the 
ague may be, indeed, removed, but other difeafes, 
of a very ferious and alarming nature, may be in- 
duced. On the other hand, cafes occur very fre- 
quently, in which, although the bark be given 
very early, and in large quantities, the ague con- 
tinues to harrafs the constitution for a considerable 
time 5 and, at length, brings on fuch an enfeebled 
State of the fyStem, as may terminate in dropfy, 
and even in death itfelf. 

Agreeable to your requeSt, I fhall occaSionally 
point out fome few paffages in your once favour- 
ite book (Buchan's DomeStic Medicine), as feem to 
be likely to be more productive of harm than of 

good; 



*>2 MEDICAL ADMONITIONS. , 

good ; accompanying them with fuch obfervations, 
as may, in my opinion, prevent you, and my other 
readers, from being lulled into the neglect arifing 
from a falfe fecurity ; or from being excited to the 
adoption of ram and dangerous meafures. The fol- 
lowing paffage is certainly not fufficiently guarded, 
to prevent its being productive of very ill confe- 
quences. — "Intermitting fevers, under a proper 
"regimen, will often go off without medicine ; and 
"when the difeafe is mild, in an open, dry coun- 
"try, there is feldom any danger from allowing it 
"to take its courfe ; but when the patient's ftrength 
"feems to decline, or the paroxyfms are fo violent, that 
"his life is in danger, medicine ought immediately 
"to be adminiftered." Domejlic Medicine, i ith edit, 
"p. 149- 

The injuries which the ftrongeft conftitution fuf- 
fers, from repeated attacks of agues, are often fo 
confiderable, as to produce the worft of confequen- 
ces. Surely, therefore, much evil may be feared 
from a paffage like this, which is fo likely to add 
to that fupinenefs, with which many are difpofed 
to fuffer the ravages of difeafe. The doctor after- 
wards fays — "When the difeafe is very irregular, or 
"the fymptoms dangerous, the patient ought imme- 
diately to apply to a phyflcian. ,, But advice like 
this cannot but be prejudicial, both to the patient 

and 



MEDICAL ADMONITIONS. 63 

arid the phyfician $ for if a patient is not to apply 
to a phyfician, until the fymptoms are fo violent^ 
that his life is brought into danger, the opportu- 
nity of obtaining his recovery may be pail: by : and 
the fatal termination of the difeafe will often be 
imputed to the want of fkill, in the attending phy- 
fician ; when, its caufe is only to be found, in the 
having permitted the tampering with domeftic 
medicine to have produced fuch effects, as no exer- 
tions of art could remove. 

The empirical practice of thofe, who depend or 
amulets and charms for the cure of this difeafe, is 
not of very dangerous tendency 5 any farther, than 
as it tends to place the patient in a ftate of imagi- 
nary fecurity ; which induces him to wafle that 
time, in which he might, by proper means, have 
gotten rid of the difeafe. There are, indeed, nu= 
merous inflances, in which we have reafon to fup- 
pofe, that the force of ftrong expectation has pro- 
duced fuch effects on the fyftem, as have put off 
the paroxyfm, and even cured the difeafe. There 
are alfo feveral hiftories of cafes related, in which 
the cure of ague has been produced by fudden and 
violent affections of the mind : by a fimiiar opera- 
tion, perhaps, it is, that thofe remedies act, the 
taking of which occafions a great degree of horror 
and difguft ; fuch is the frequently mentioned 
remedy of fwallowing a large fpider, maflied, and 

• formed 



'J.l MEDICAL ADMONITIONS; 

formed into a bolus, or involved in its web. Othe£ 
remedies recommended by thefe practitioners are 
not fo innocent,. fuch as a large dofe of gin, with 
the addition of pepper, or the fudden application 
of cold water to the whole furface of the body* 
A melancholy inftance of the ill effe&s of the lat- 
ter practice I once witneffed, in a young man, who 
had been for fome time afflicted with an autum- 
nal quartan : the good woman of the houfe, hav- 
ing purpofely procured his removal out of the bed; 
fuddenly threw over him a pail of cold water : the 
whole furface of the body direftly had its florid hue 
changed for a livid purple, a considerable oppref- 
fion of the cheft, with other alarming fymptoms, 
directly came on, and, notwithstanding the em- 
ployment of the moft powerful means to fave him, 
he expired in a few hours. 

The REGIMEN mull neceuarily be adapted to 
the feveral ftages of the diforder. In the cold fit, 
it is moft likely, the patient will not be inclined to 
take much ; a little barley-water, water gruel, or 
camomile-tea, for the fake of promoting ficknefs, 
will perhaps be all that is neceflary. During the 
hot fit, the drinks may be barley-water, mint-tea, 
or orgeat ; to which may be added,, if the patient 
wifhes it, the juice of lemons or oranges, and a 
fmall quantity of the fyrup of capillaire ; although 
the fweat is, in general, fuppofed to be fooner in- 
duced, 



MEDICAL ADMONITIONS. 6^ 

duced, by thefe drinks being given flightly warm, 
yet it is hot neceffary, that the patient mould be 
entirely debarred, from the luxury of a draught of 
cold toaft and water. When the fweating begins, 
the drinks I have juft enumerated may have a little 
white wine added to them j and, if the patient be 
able to take it, he may have a bafon of beef-tea, 
fago, falop, &c. During the time of intermiflion, 
the diet mould be as nutritious, as the patient's 
appetite and digeflion may prompt him to adopt. 

Every thing which contributes to keep up the 
natural difcharge, by the pores of the fkin, and 
which gives ftrength and tone to the vefTels, is ufe- 
ful in the cure of this difeafe ; hence exercife muft 
be peculiarly proper, fince nothing tends more to 
produce thefe beneficial effects. The exercife mould 
be of that kind, to which the patient has been moft 
accuftomed ; and taken in the open air, unlefs wet 
weather, or damp fltuation, forbids it. Care muft 
be likewife taken, that it be not ufed to fuch a 
degree, as to occafion much fatigue ; fince that 5 
inftead of reftoring ftrength, muft induce debility. 

Prevention. Thofe who are particularly liable 
to returns of this difeafe, ftiould endeavour to 
mend that peculiar ftate of the fyftem, which is 
known to produce a difpofition to it. This is to 
be accomplifhed by avoiding, as much as pofllble ? 
I the 



66 MEDICAL ADMONITIONS* 

the circumftances above enumerated, under the 
head of remote caufes, and carefully attending to 
the advice juft given, as to regimen and exercife. 



INFLAMMATORY FEVER. 

This fever is very rarely met with, efpecially in 
this climate, unlefs accompanied with the inflam- 
mation of fome particular part.* 

A confiderable degree of fhivering, and fevere 
pain in the fmall of the back, are the firft fymptoms 
of this fever. Thefe are fucceeded by an intenfe 
heat of the whole body ; the countenance becomes 
of a deep crimfon colour, every veffel appearing 
turgid with blood ; the eyes are red, and fufFer 
much uneafinefs from the admiffion of light ; the 
arteries in the neck and temples throb violently ; 
the pulfe is ftrong, rapid, and full j the ikin, tongue, 
and all the infide of the mouth, are parched j the 
urine of a very high red colour j and the patient 
complains of the moft infatiable and diftreffing 
thirft. He likewife fuffers from difficulty of breath- 
ing, and a confiderable pain and confufion in his 
head ; and toffes about in the bed, from exceffive 
reftleflhefs. A delirious ftate foon comes on ; and, 

if, 

* Dr. Blane obferves, that the continued inflammatory fever 
is very uncommon in the Weft-Indies. 



MEDICAL ADMONITIONS. 67 

if the difeafe be not oppofed by fuccefsful means, 
this fymptom becomes fo violent, that the exertions 
of four or five perfons will be hardly Sufficient to 
retain the patient in his bed. Soon after this, hic- 
cough, ftarting of the tendons, involuntary dis- 
charges, and cold, clammy fweats, Shew, that na- 
ture is nearly exhaufted, and the difeafe invincible. 

Fevers which, in the courfe of a few days, will 
mew Strong marks of their being of the putrid kind, 
may commence with fymptoms fo nearly refem- 
bling thofe of the fever juft defcribed, as to render 
it very difficult to diftinguifh the one from the 
other. But thefe difeafes differ fo much, in their 
real nature, and in the mode of cure they require, 
that a miftake would, moft probably, be Succeeded 
by the moft dreadful confequences. 

The cure of this fever is to be obtained by timely 
bleedings, proportioned to the ftrength of the 
patient, and the violence of the difeafe ; antimo- 
nial medicines, given with a careful attention to 
their dofes, and the effecls they produce ; the free 
adminiftration of opening medicines ; and the ufe 
of vegetable acids, neutral falts, fudorifics, &c. as 
the fymptoms may indicate. But fhould even the 
difficulty of afcertaining the difeafe be removed, 
and the malady be exactly known by the family 
practitioner, he certainly would not dare to attempt 

its 



6S MEDICAL ADMONITIONS. 

its removal : when, from his inability, not only of 
making a proper felection of the means, but of de- 
termining alfo the extent to which they may be 
employed, the life of his patient might very likely 
be loft. 

Regimen. This difeafe depending on too great 
an action and fulnefs of the veffels, it is obvious, 
we fhould carefully avoid fuch things, as may be 
likely to increafe either of thefe circumftances. 
The room mould be kept cool, by a conflant fuc- 
ceflion of frefh air ; the covering of the patient 
fhould not be fuch, as to allow of the accumula- 
tion of the heat of the body. The body ihould be 
kept, as nearly as poflible, in a ftate of reft ; and, 
if the head appears to be difpofed to be deranged, 
the body mould be placed, as much as poflible, in 
an erect pofture. Animal food, of every kind, 
muft be ftrictly refrained from, even in the form 
of broths j as well as all aromatic, fpirituous, and 
even the weakeft fermented liquors. Thirft may 
be allayed by drinking freely of watery liquors, 
made pleafantly acid with the juices of lemons, cit- 
rons, oranges, currants, &c. for this purpofe, bar- 
ley-water, mint and balm tea, anfwer very well ; 
and, for the fake of greater variety, orange-whey, 
tamarind drink, lemonade, orgeat, and capillaire, 
may be mentioned, as being well calculated for the 
fame purpofe. Oranges, currants, grapes, in faft, 

every 



MEDICAL ADMONITIONS. 69 

every fruit which the feafon affords, may be al- 
lowed ; and, when other fruit is not to be obtained, 
apples, roafted or boiled, may fupply their place. 

The chamber mould be kept as quiet as poflible, 
and fomewhat darkened. The patient fhould con- 
verfe no more than is abfolutely neceffary ; and 
every circumftance, likely to intereft his mind, 
mould carefully be kept from him. If the pro- 
moting of fweating be intended, the hands and 
feet mould be frequently bathed, or fomented with 
warm water. 

The prefent opportunity muft not be paiTed over, 
of remarking on the evil confequences arifing from 
the neglecting of the phyfician's orders, with r-e- 
fpect to the conduct of the patient, as to his regi- 
men, &c. It is too frequent a practice, as has been 
before obferved, with nurfes, and other attendants 
on the lick, to make fuch alterations, in this refpect, 
as may reduce the plan recommended, a little 
nearer to their own ideas ; and it generally hap- 
pens, that this liberty is taken, even in thofe difea- 
fes, where an attention to thefe circumftances is 
moft neceffary : for there the reftri&ions propofed 
are fuch, as are moft likely to meet with oppofi- 
tion from the ignorant. Thus, by a miftaken ten- 
dernefs, the diet above prefcribed, will often be va- 
ried, and the life of the patient brought into dan- 
ger, 



JO MEDICAL ADMONITIONS. 

ger, by thofe who think, a patient muft foon be 
ftarved under fuch a regimen. But, with the hope 
of preventing this dangerous interference, it muft 
be here obferved, that, in this ftate, the patient 
will not only derive no more fupport from the moft 
nourifhing diet, than from that which is here di- 
rected, but that he will be rendered, by it, more 
languid and uncomfortable : for the ftomach, par- 
ticipating in difeafe with the reft of the fyftem, 
performs its functions very imperfectly ; hence a 
very fmall part of this food is digefted, and con- 
verted into chyle, while the remainder occafions to 
the patient, the moft diftreiling fenfations of anx- 
iety and oppreflion. 



SLOW NERVOUS FEVER. 

It is fuppofed, by fome phyficians, that the flow 
nervous fever, and the putrid malignant fever, are 
the fame fpecies of difeafe : and that the putrefcent 
ftate of the fluids, difcoverable in the latter, is an 
incidental circumftance ; and therefore, only ren- 
ders it a variety of the fpecies : whilft others have 
fuppofed them to be difeafes of entirely different 
fpecies. But fince, from the occurrence of fymp- 
toms denoting putridity, a confiderable difference 
is required in the treatment, it is thought proper, 
without entering into the merits of the queftion, 

to 



MEDICAL ADMONITIONS. Jl 

to treat of them feparately ; as the more appro- 
priate mode of treatment, in each cafe, may thereby 
be more clearly fhewn. 

The infidious manner in which this difeafe makes 
its attacks, is one reafon of* its fo frequently termi- 
nating fatally. The firft departure from health is 
fo gradual, and the fymptoms fo ambiguous, that 
very frequently the patient will have fufFered the 
difeafe to have made a very confiderable progrefs, 
before he efteems it neceffary to apply for afliftance: 
and often will a difcerning phyfician, when firft 
called in this difeafe, difcover a patient to be in a 
very alarming condition, who is not fufpected, by 
himfelf or his attendants, to be in the leaft degree 
of danger. If this be duly confidered, it muft im- 
prefs the mind of every one, with a conviction of 
the neceffity of immediate application for regular 
medical help, at the firft appearance of thofe fymp- 
toms, which, in the following hiftory of the difeafe, 
mark its beginning. If this be done, there is the 
greateft probability, that the train of dreadful 
fymptoms, which is there defcribed as coming in 
fucceflion, will be checked in their approach. 

The History of the Disease. This difeafe, 
in general, begins with extreme liftlefsnefs, and un- 
willingnefs to move, with a fenfe of wearinefs ; 
indifference to £ood, naufea, depreflion of fpirits j 

and 



72 MEDICAL ADMONITIONS. 

and frequent flight and irregular chills, alternating 
with tranfitory flufties of heat. A dull and heavy 
pain, with a fcnfe of coldnefs, pofTefTes the back 
part of the head, and is accompanied by a flight 
giddinefs ; the difinclination to motion increafes, 
the countenance is flirunk and pale, bearing evi- 
dent marks of anxiety ; the breathing is perform- 
ed with fome little difficulty, the patient complain- 
ing of an oppreflion on the cheft, and a tightnefs 
acrofs the pit of the ftomach ; frequently fighing, 
without knowing for what caufe. The fymptoms 
generally get worfe as evening comes on ; nature 
obtaining, at night, fome flight refrefhment, from 
fhort flumbers, interrupted by difagreeable dreams. 
The urine, in this firft ftage of the difeafe, is moftly 
clear and colourlefs. Thefe fymptoms gradually 
increafe for a few days, when the pulfe becomes 
fmaller, and at the fame time quicker, than natural; 
the tongue gets lightly covered with a thin mu- 
cous coat, which feems hardly to adhere to it. 
After the firft week is paft, the fymptoms will, in 
general, be found much increafed ; the fight of 
food, efpecially of an animal nature, excites difguft; 
the ihiverings are lefs, but the heat is in general 
more increafed, and the cheeks are frequently very- 
much fluihed ; the anxiety and inquietude of the 
patient becomes more intolerable, the giddinefs and 
pain of the head more diftrefling, light and noife 

occafioning 



Medical admonitions. y^ 

tfc'cafioning much uneafmefs ; the tongue becomes" 
dry, red, and divided by large chaps : the urine, 
about this time, frequently depofits a bran-like fed- 
iment. The patient obtains no refrefhment from 
his {lumbers, whicli are very much difturbed ; he" 
frequently mutters vague and unconnected fenten- 
ces ; the hands tremble fo, as to prevent his guid- 
ing them to his mouth ; the fingers are in con- 
ftant motion ; the tendons agitated with frequent 
ftartings ; the pulfations fo fmall and quick, aslwith 
difficulty to be counted ; the tongue trembles 5 
and is with difficulty put beyond the lips. A pro- 
fufe fweating in fome, and a frequent purging in 
others, alfo occur, as the difeafe advances. If the 
remedies which have been had recourfe to, fail of 
producing the wifhed effects, fymptoms will foon 
appear, declaring, the near approach of death : thefe 
are, a coldnefs of the extremities, which feem 
ihrunk, and of a pale, and almoft livid hue ; the 
nails appear almofl of a blue colour ;• the eyes lofe 
their fenfibility and luftre, fwimming in tears* 
which now and then trickle down the cheeks y 
the ftools and urine are voided without the patient's- 
knowledge ; the brain becomes fo affected, that all 
recollection and fenfe is loft. A conftant delirium 
accompanies this ftate, but without any efforts of 
violence :, the deranged ftate of the mind, however, 
being fufftciently evident, from a conftaiit mut- 



74 MEDICAL ADMONITIONS, 

tering of incoherent and fcarcely articulated founds 
Convulfive motions affecting the whole frame, or 
an infenfible comatofe ftate generally clofing the 
fcene. 

But fbmetimes, even when the greateit part of 
the above fymptoms have come on, and death ap- 
pears, to a common obferver, as the inevitable con- 
fequence ; a fudden amendment will take place, 
produced, either by the happy effects of medicine, 
or fome unexpected, favourable effort of nature. 
Inftances of fuch recoveries are by no means un- 
common j and render the caution, contained in 
the following paragraph, abfolutely neceffary. 

When the greater part of the above defcribed 
appearances, are obferved in a patient, the defpair, 
and confequent inactivity, produced in his attend- 
ants, however they may be regretted, can by no 
means be wondered at : the fymptoms feeming to* 
mew, that death muff foon put an end to the cal- 
amities of the unhappy fufferer. So great a degree 
of defpair, indeed, poffeffes the by-ftanders, in thefe 
diftrefiing cafes ; that frequently, when the medi- 
cal man fees confiderable ground of hope, they will, 
in the ftrongeft terms, condemn all attempts for his 
recovery, as ufelefs and cruel : fince they imagine,- 
that by thefe fuppofed vain attempts, his torments 
are increafed, and their* duration prolonged. To 

the 






MEDICAL ADMONITIONS. J$ 

the frequency with which this idea is adopted, may- 
be attributed the death of numbers : for it feldom 
happens, when this opinion is entertained, that the 
ftrongeft remonftrances of the phyfician, can pro- 
duce the leaft exertions of the attendants, except, 
indeed, during the time he is prefent ; for imme- 
diately after his departure, all exertions ceafe. 

It is a circumftance that muft have occurred 
often, to every medical man, that having left a pa- 
tient, in this, or the putrid fever, with the moft 
earneft entreaties to his attendants, to fupply him 
regularly with medicines, and almoft conftantly 
with nourishment, he fhall be told, at his next 
vifit, that they have not been able to procure the 
fwallowing of a drop of either : and mould he or- 
der the experiment to be made before him, it will 
frequently happen, that the patient will take what 
is Dffered to him, not only with eafe, but with 
avidity. Such conduct cannot find a fufficient ex- 
cufe in mifapplied tendernefs j fince the confe- 
quence, refulting from fo culpable an omiffion, may 
be the death of one, who otherwife might have 
been faved : for, in all the long catalogue of difea- 
fes to which we are fubjecl, there are none, in which 
fymptoms of fo alarming an appearance are to be 
found, and where fo great a poflibility of recovery 
may exift, as in this, and the putrid malignant fe- 
ver. Inftances of recovery, from thefe difeafes, 

have 



g6 MEDICAL ADMONITIONS. 

have been fo really wonderful ; that fo long as the 
patient breathes, his attendants ihould not devote 
themfelves to defpair ; but Ihould perfift in their 
endeavours with unabated affiduity. 

Having already given you reafon to fuppofe, that 
I would not fcruple to ftep out of my way, to give 
an ufeful admonition, I fhall not apologize for the 
digreflion, but point out one of the difadvantages 
refulting from intemperance. A phyfician, who is 
called to a patient afflicted with this or the putrid 
fever, will not fail to make enquiry refpecting his 
former mode of living ; fince on the anfwer he ob- 
tains, his prognoftic of the event of the difeafe will 
coniiderably depend : for, fixould the patient have 
unhappily devoted himfelf, to habits of debauchery, 
and intoxication, there will be greater reafon to ap- 
prehend a fatal termination of the difeafe. 

To attempt to furnifh the domeftic practitioner, 
with information fufficient, to enable him to under- 
take the cure of this fever, would be fruitlefs ; fince 
it would be certainly fafer, to omit medicine en- 
tirely ; than to entruft the management of the pa- 
tient, in fo dangerous a malady, to any but thofe, 
who are enabled, by their knowledge of the human 
frame, and of the difeafes to which it is fubjecl:, to 
diftinguifh critical and falutary changes, from thofe 
which are of a contrary tendency. 

So 



MEDICAL ADMONITIONS. fy 

So general is an averfion to medicine, and fo 
great is its fway over weak minds ; that every 
eircumftance, which tends to fupport its tyranny, 
ought to be oppofed : fince it is not to be doubted, 
that many have loft their lives, rather than mortify 
their tafte, or give up prejudices, which would ap- 
pear ridiculous even in a child. Dr. Buchan, whilft 
treating of the nervous fever, fays, "Though blift- 
" ering, and the ufe of cordial liquors, are the chief 
h things to be depended en, in this kind of fever ; yet, 
^for thofe who may choofe to ufe them, we mall mention 
& one or two of the forms of medicine, which are 
* c commonly prefcribed in it. 1 ' Now it is very 
reafonable to fuppofe, that many, who are guided 
by thofe ftrong averfions and prejudices, which I 
have jufl mentioned ; if attacked with the difeafe 
we are treating of, would eagerly catch at this au- 
thority, and refufe to make ufe of any thing, but 
blifiers and cordial liquors / they being, they would fay, 
the chief things to be depended on, in this kind of fever ; 
leaving other remedies for thofe who may choofe to ufe 
them. The very great attention, which has been, 
of late years, paid to this fever, has rendered the 
practice of phyficians, of thefe days, exceedingly 
fuccefsful ; fo much fo, that the cafe muft be at- 
tended by extraordinarily dangerous circumftan- 
ces, to prevent a cure being accompliflied ; even if 
the patient have but a fmall degree of ftrength left. 

But, 



7$ MEDICAL ADMONITIONS. 

But, notwithstanding this, the beft informed phy- 
ficians know, that the various diftrefling fymptoms 
which occur, oblige them to have recourfe to fev- 
eral powerful, and ufeful articles of the materia me- 
dica. 

The Regimen. After the ftomach and bowels 
have been cleared, the patient may be fupplied with 
food of a light and nutrient kind ; fuch as fago, 
rice gruel, panada, and falop, according as his in- 
clination may dictate. Good white wine may be 
added to thefe, as may be indicated by the ftate of 
the pulfe, and degree of languor ; and, for the fake 
of variety, he may be allowed to drink of red wine 
negus, bottled cyder, perry, and particularly, if the 
patient entertains a defire for it, porter. Animal 
food mould be avoided ; unlefs the patient is anx- 
ious for it, when it will feldom do harm. But 
when the patient regains a defire for food, it will 
be beft to begin with puddings of various kinds, 
fliell fifh, &c. refuming his ufual diet gradually, as 
he finds his health return. 



PUTRID MALIGNANT FEVER. 

The effluvia arifing from the human body, ac- 
cumulated, and long retained in the cloathing, &c. 
and the effluvia arifing from the bodies of thofe 

labouring 



MEDICAL ADMONITIONS. 79 

labouring under this difeafe, are allowed to be the 
moll ufual caufes of this fever. 

The Symptoms. This fever fometimes comes 
on with a great degree of rapidity ; but moft fre- 
quently it attacks in the fame flow and infidioui 
manner, as was remarked to be the cafe, with the 
flow nervous fever, juft defcribed. The fhiverings, 
with which it in general commences, are, in fome 
Cafes very flight and tranfitory ; in others, they 
are very violent. The fliivering is fucceeded by 
febrile heat ; with pain in the head, loins, and, for 
the moft part, alfo in the limbs ; the dejedtion of 
fpirits, as well as the lofs of power in the whole 
nervous fyftem, is particularly obfervable. The 
pulfe is fmall, hard,, and quick. Naufea and vomi- 
ting, are, alfo, among the fymptoms which appear 
fit the commencement of this fever. The eyes foon 
have their luftre diminifhed ; their glaffy part ap- 
pearing dull, and that part which is termed the 
white of the eye, becoming of a yellow hue, blend- 
ed with red. The patient's breathing becomes la- 
borious ; and interrupted by frequent, deep, in- 
voluntary fighings : and the cheeks affume a deep 
crimfon, approaching to a purple. As the difeafe 
advances, the pulfe increafes in quicknefs, but lofes 
its hardnefs. The heat increafes ; fo as to give a 
very uneafy and lafting fenfation of heat, to the fin- 
gers of any one, who applies them to the 1km of 

the- 



Sc MEDICAL ADMONITIONS. 

the patient. Small red fpots appear on the fkin r 
refembling thofe remaining after the bites of fleas. 
The tongue gets exceedingly dry, and is, in gene- 
ral, covered with a hard rough coat, of a dark 
brown colour ; the gums, and part of the teeth, 
are coated with a fimilar covering. At length, if 
the remedies ufed, do not prove fufficient for the 
removal of the difeafe, the pulfations of the arteries 
are reduced to indiftinct, tremulous vibrations ; the 
fpots in the ikin increafe in number, and change 
their colour to a livid or dark purple. The patient 
conftantly employs his trembling fingers, as though 
engaged in picking flocks off the bed-clothes, or, 
as in purfuit of fome infecl: : this he continues, 
until a ftate of fleepinefs fucceeds to that of deliri- 
um ; which foon terminates in fo lethargic a ftate, 
that the patient can hardly be roufed, by the utmoft 
endeavours of the attendants. Difcharges of blood 
from the noftrils, mouth, kidneys, &c. fometimes 
happen juft before the death of the patient ; which 
is generally preceded, alfo, by convulfive motions 
of the whole frame. 

The urine, through the whole of the difeafe, 
differs much in its appearance. The ftools vary 
much, in different fubjects, as to their frequency : 
in general, there exifts a coftive ftate of the bowels, 
in the firft days of the fever ; and a fatiguing and 
deprefting purging, towards the clofe. Sweating. 

which 



MEDICAL ADMONITIONS. 8 1 

which, in general, is obtained with great difficulty* 
in the early part of the fever ; often comes On very 
profufely, after the firft eight or ten days ; when 
it is fometimes critical, and denotes a favourable 
termination of the fever : but fometimes it is 
merely a confequence of the debilitated ftate of the 
fyftem, which, in that cafe, it invariably increafes* 

When the fcene is contemplated, which has been 
juft defcribed ; the propriety of not offering, in a 
publication of this kind, to deliver a plan of cure, 
muft be fo obvious -, as to render it unneceffary to 
offer any other reafons, than thofe which were 
given, when treating of fevers in general. 

When doubt and alarm are excited, by fuch a 
variety of diftreffing fymptoms, the friends of the 
patient muft poffefs, more than ufual hardinefs, to 
venture to affume the office of the phyfician. But, 
unfortunately, there are many perfons, who, al- 
though they will not defend on their own judge- 
ment, in propofing a mode of cure, will fubmit, at 
the recommendation of fome ignorant, but well 
meaning friend, to ufe fuch remedies, with bold- 
nefs, which a perfon, properly informed, would 
ufe with the utmoft timidity. Thus, bleeding is 
often had recourfe to, immediately on the appear- 
ance of fever, it being the popular opinion, that 
bleeding is the moll effectual means of removing 
t that 



8 5$ . MEDICAL ADMONITIONS. 

that difeafe ; whereas, the fact is, that there is not 
one cafe of fever in a hundred, that will admit of 
this evacuation. Cafes of this, and of the preced- 
ing fever, in which it is proper, are very rare in- 
deed. The mifchiefs, which fucceed to its being 
improperly had recourfe to, in thefe fevers, are, in 
general, fo great ; that no exertions, however fk.il- 
ful and vigorous, prove fuflicient, afterwards, to 
fave the life of the patient. 

Dr. James's Powder and Emetic Tartar are med- 
icines, which are, almoft always, employed, by fam- 
ily practitioners, in their attempts to remove fevers* 
But the operations of thefe, and of other antimo- 
nial medicines, are, in general, fo violent, as to re- 
quire the utmoft caution in admiriiftering them. 
Not only is it neceflary, that their dofes fhould be 
exactly adapted ; but alfo, that a ftrict attention 
mould be paid, at the fame time, to various other 
eirciimftances, to fecure their beneficial effects. 
When, in addition to thefe confiderations, it is re- 
collected, that debility of the fyftem is that ftate, 
which moft certainly renders this difeafe fatal, the 
affertion rnuft obtain belief, that the ignorant em- 
ployment of remedies, fo powerfully debilitating, 
mufl be accompanied with the greateft degree of 
danger. The celebrated Dr. Goldfmith loft his 
life, by the imprudent adminiftration of Dr. James's 
Powder, as was clearly proved in the account of 

his- 



MEDICAL ADMONITIONS, ' ' 83 

|i£s illnefs, publifhed by his worthy medical attend- 
ant, Dr. Hawes. Numerous other inftances might 
be adduced, of mifchiefs fucceeding the employ- 
ment of this, and fimilar medicines, by domeftic 
practitioners. 

Another dangerous mode of treatment, which 
is frequently adopted in families, on the firft ap- 
pearance of fever, is ; that of confining the patient 
to his bed, under a great load of bed-clothes, in a 
clofe, heated chamber y and plying him, profufely, 
with hot and fpirituous drinks, for the purpofe of 
forcing out perfpiratign. But this effect feldom 
follows the ufe of thefe means y but, on the con- 
trary, the conferences of thus increaling, that 
heat, which already exifts in a morbid degree, will 
be found to be ; the augmenting of the parched 
ftate of the Ikin, and Hill more rigidly doling its 
pores ; whilft the vigour of the fyftem, is, at the 
fame time exhaufted, by this accumulation of irri- 
tating circumftances. 

Regimen, and. Management of the Pa- 
tient. Previoufly to delivering the advice which 
may be thought proper on this head, it is neceffary 
to obferve, that fo much depends on the care and 
vigilance of the attendants, that na ordinary nurfe 
ought to be trufted with this office ; unlefs the 
phyfician is exceedingly exacl; and decilive, in his 

erders 



84 MEDICAL ADMONITIONS. 

orders ; and the friends of the patient equally care- 
ful in feeing, that his directions are literally obeyed. 

Whilft endeavouring to obtain the cure of this 
fever, the phyfician will be anxious to iupport the 
ftrength of the patient, and to oppofe the tendency, 
to putrefcency, which takes place in the fyftem, 
To aflift in the accomplifhing of thefe intentions, 
is the office of the nurfe ; and of thofe, who take 
on themfelves the kind, and important tafk, of 
tending the fick : and is only to be executed, with 
advantage to the patient, by paying a ftrict atten- 
tion to the following points : the due adminiftra- 
tion of nourishment and medicines ; the free admif- 
iion of frefh air ; the preventing of the accumula- 
tion of putrid effluvia ; and the careful ufe of fuch 
means, as may be directed, for the alleviation of 
particular fymptoms. 

With refpect to nourimment ; it mould not 
only be light and eafy of digeftion, but it mould 
alfo be of an antifeptic nature. It may, therefore, 
be compofed of fago, falop, panada, &c. to which 
may be added, wine, in a quantity proportioned 
to the ftate of the patient. A glafs of pure wine, 
fuch as is molt agreeable to his palate, may be alfo 
frequently allowed ; in which may be dipped a 
piece of toaft or bifquit. Where it is thought 
proper to truft more to their antifeptic, than to 

their 



MEDICAL ADMONITIONS. 85 

their cordial properties, wines made from fruit of 
our own growth, are preferable ; fuch as wine 
made from currants, which contain a greater pro- 
portion of the vegetable acid, or, at leaft, in a lefs 
involved ftate, than is to be found in the foreign 
wines. Cyder and perry, efpecially if bottled, are 
exceedingly beneficial. But if, as is frequently the 
cafe, nature requires the free ufe of cordials ; none 
are fo falutary as claret, hock, or even the more 
generous wines, fuch as port, fherry, or Madeira. 
Where the circumftances of the patient prevent his 
obtaining any of thefe, in the quantity required, 
bottled ale, or porter, will prove very ufeful fub- 
ilitutes. Nothing will be more ferviceable, in cor- 
recting the ftate of the fluids, than the free ufe of 
ripe and frefh-gathered fruits ; of thefe, the moll 
preferable are currants, mulberries, oranges, ftraw- 
berries, grapes, and rafpberries. When thefe can- 
not be had, their place may be fupplied, by thofe 
fruits which may be in feafon ; or which allow of 
being preferved fome time, as apples, pears, &c. 
and if thefe cannot be obtained, recourfe muft 
be had to dried fruits and jellies, or marmalade, 
made by boiling the juices, or pulps of fruits with 
fugar. Jelly, made of ilinglafs or hartfhorn £hav- 
ings, is very ufeful ; being a very proper Vehicle 
for the wine and acids ; and conveying nourifli- 
ment, at the fame time, into the fyftem. Beef-tea 3 

or 



86 MEDICAL ADMONITIONS. ' 

or broths, when ordered, fliould be made ftrong 
of the meat ; but carefully cleared from every par- 
ticle of fat. The drinks, which may confift of ap- 
ple-liquor, wine negus, barly-water, &c. fliould be 
.given cold, and impregnated with the juice of 
lemons, oranges, or citrons. Inftead of common 
water, Seltzer water mould be ufed, for all the 
drinks, which are prepared without heat. When 
the difeafe is nearly gone off, and the ftomach ap- 
pears to be regaining its powers, of digefling and 
affimilating the aliment it receives ; beef-tea, and 
broths made of different animal fubftances, mould 
be given more freely, and even folid animal food, 
may be permitted : efpecially if the patient anx- 
ioufly requeft it : fince it very feldom happens, 
that any ill confequence follows, from indulging 
the patient in thofe defires : befides, that the vex- 
ation and difappointment, confequent to the refu- 
fal, might not be without injurious effecls. 

During the violence of the febrile heat, the pa- 
tient fliould be allowed the indulgence of cold 
fpring water, for his drink j and may frequently 
be refrefhed, by wiping his face ; hands, and arms, 
with cloths dipped in cold water, to which a little 
vinegar has been added. This recommendation, 
of the application of cold water to the furface of 
the body, may not feem to accord with the cafe I 

related, 



MEDICAL ADMONITIONS. ■ 87 

related, when treating of ague, of a young man, 
who was killed by having a pailful of cold Water 
thrown over him. But this poor fellow, worn 
down by a quartan ague, had been endeavouring, 
during the fliivering fit, to excite fome heat, by 
hovering over the fire ; and had juft retired to \\\i 
bed, ftill fliivering, when the unfortunate affufion 
took place. But, in fever, Dr. Currie, phyfician 
to the Infirmary of Liverpool, has fhewn, that cold 
water may be poured over the naked body, not 
only without injury, but with confiderable benefit ; 
but this muft be done, where circumftances are 
widely different, from thofe which exifted in this 
cafe :— the ftrength mould riot be greatly reduced ; 
the heat mould be fteadily above the temperature 
of health ; and no fenfe of chilliriefs mould be pre- 
jfent. The practice, fuccefsfully employed by Dr, 
Currie, is not, however, to be adopted, without 
due information : the rules juft mentioned, may, 
however, be of fome advantage in directing the 
ufe of cold water, as a drink, &c. 

Before I conclude thefe inftrudtions, On the arti- 
cle of regimen, it is neceffary to add 5 with refpect 
to the ufe of wine, that, although it be abfolutely 
neceffary during the continuance of this fever ^ 
and that, in fuch quantities, as to render it furpri- 
fing how confiderable a portion may be taken 3 
without producing any of thofe effects, which 

would 



83 MEDICAL ADMONITIONS. 

would have proceeded from even a much left quan- 
tity, if taken by the fame perfon, when in health : 
yet, as foon as the fever has left the patient, much 
caution becomes neceffary in the- ufe of it ; fince 
very difagreeable circumftances may follow, from 
too free ufe of it at this time. Several inftances 
have been feen, where patients juft recovered from 
this fever, during which they had fwallowed, with 
falutary effects, confiderable quantities of wine* 
have, upon drinking only a few glaffes during 
their convalefcent ftate, experienced the return of 
a confiderable degree of febrile heat, and even of 
delirium : nor, have thefe confequences been either 
foon or eafily removed. For although, during the 
difordered ftate of the fyftem, accompanying the 
fever, the patient be able to bear a much greater 
quantity of wine, than when in perfect, health ; 
yet, when the fever entirely ceafes, the wine, not 
only affects him as before ; but feems to have be- 
come capable of producing injurious confequences, 
in proportion to the degree of debility induced. 

For the fake of preventing the accumulation of 
putrid vapours about the patient, great attention 
mould be paid to the ventilation of the room, and 
to the frequent changing of the bed clothes. The 
patient mould not be confined to one room, but 
be removed from one to another : that which he 

has 



MEDICAL ADMONITIONS. 



has left, having the windows and doors all thrown 
open, for the free paffage of the air j the floors 
wiped with cloths, dipped in vinegar j and fuch of 
the bed-clothes, as are not changed, expofed to the 
current of air; fmce, by their known capacity for re- 
taining effluvia, they may become fo loaded with 
contagious and putrid matter, as to prove infectious 
to the attendants, and perhaps to impede the re- 
covery of the patient. The apartment may be 
frequently fprinkled with rofe-water, or vinegar, 
and filled with the odours of ftrong fmelling plants. 
The fick perfon, in fome cafes, ihould be kept out 
of bed as much as poilible ; and placed fo, as to 
face the current of air ; the body being defended 
fufficiently by the clothing, to prevent any incon- 
venience being experienced ; but not fo much fo, 
as to heat the patient. It mull: be allowed, that 
this practice is not admiflible, in every cafe of put- 
rid fever ; fmce circumftances may arife, which will 
render it highly improper : thefe circumftances, 
depending on various combinations, of the feafon 
of the year, weather, conftitution of the patient, 
&c. will be difcovered and pointed out by the phy- 
fician. But there is much lefs reafon to fear, that 
this practice will be too frequently adopted ; than 
that it will be neglected, in thofe cafes in which it 
is recommended. For, too often, in this point, 
are the wifhes of the phyfician oppofed, and his 

M directions 



go MEDICAL ADMONITIONS. 

directions difobeyed : the languor of the patient, 
and his unwillingnefs to be moved, with the pre- 
judices againft a practice fo novel, forming, very 
often, almoft infuperable obftacles. Indeed, it is 
very difiicult to perfuade thofe, who have not wit- 
nefTed the effects refulting from this mode of prac- 
tice, that it is not neceffary, for every perfon in a 
fever to be kept clofely confined to his bed, under 
a load of bed-clothes, and fupplied with heating 
drinks. It frequently happens, therefore, that no 
fooner has a phyfician left the room ; than the 
patient is fupplied with warm liquors, the windows 
and curtains are clofed, and the bed-clothes, which 
had been removed, are replaced. Such oppofition 
to the directions of a phyfician, viewed in the moft 
favourable light, is highly cenfurable : its being, in 
a great meafure, the effect of ignorance, is all that / 
prevents it from being really criminal. 

Among the fymptoms which occur in this fever, 
no one requires more care and management, than 
the delirium, which, in general, accompanies the # 
difeafe, almoft through its whole courfe. During 
this delirious ftate, the patient is agitated with 
vague and irregular exertions, both of body and 
mind ; which muft necelfarily, in proportion to 
their frequency, and length of continuance, exhauft 
the vital powers. To leffen thefe exertions, mould 
be the talk of fome difcerning and intelligent at- 
tendant ; 



MEDICAL ADMONITIONS. 9 1 

tendant ; who ftiould gently reprefs the patient's 
efforts, and foothe his anxiety. 

Dr. Blane, in his obfervations on this fever, has 
fome remarks on delirium, which, from their ex- 
treme utility, and from their being only to be found 
in a publication, not likely to be read but by pro- 
fefiional men, I {hall introduce here ; with the 
hope of more widely extending the comforts, which 
they were meant to procure, to the unfortunate 
victims of this difeafe. "Delirium," he faysj 
"feems chiefly to confift in a falfe reference of our 
"fenfations, whether external or internal : and 
"this is, in no fort of fever more evident, than in 
"this. When any painful impreffion, for inftance, 
"is made by an external body, the patient, if in a 
"ftate of delirium, does not refer it juftly to the 
"part affected ; but the -general agitation, and in- 
" coherence of fentiments, will be aggravated for 
"the time. I have known a degree of heat applied 
"to the extremities, fufficient to blifter them ; yet 
"the part did not fhrink, though the raving and 
"general uneafinefs were in>reafed. In like man- 
"ner, with regard to internal fenfations, when an 
"irritation is excited, to expel the urine, or faces, 
"the mind does not recognife it as fuch, but from 
"a fenfe of uneafinefs, probably miftaken for fome- 
" thing elfe, an effort is made to relieve nature, 

which 



p3 MEDICAL ADMONITIONS. 

"which is done without a proper confcioufnefs, 
"and certain fymptoms are produced, which are 
"well known marks of danger in this fever. In 
"watching thofe, who have been under the in- 
"fluence of delirium, I have obferved it increafe, 
"when any particular want of nature purged ; and 
"this would continue for fome time, the patient 
"being incapable of procuring himfelf immediate 
"relief, on account of the falfe reference of fenfa- 
"tion, that has been mentioned ; but he would 
"become calm after voiding the urine or faces, or 
" after receiving fomething to drink, according to 
"the particular want that was prefent at the 

"time."* "Delirium is one of the molt con- 

"ftant and alarming fymptoms in this difeafe, and 
"the removing of it depends much upon the attend- 
ants, as well as the phyfician. 1 have feen a 

"temporary flop put to the patient's raving, by 
"making him drink, or upon his difcharging 
"his urine or faeces ; for he is then unconfcious 
"of thirft and other natural wants, is therefore 
"ignorant of the means of fatisfying them ; and 
"when he does fo, he fancies he is about fomething 
"elfe, which is the fubjecl: of his delirious thoughts. 
"This obfervation leads to a material practical 
"purpofe ; for it follows from it, that unremitting 
"attention mould be given to the patient's feel- 
ings, 

* Obfervations wi the Difeafes of Seamen, by Gilbert Blane, 
M. D. p. 374. 



MEDICAL ADMONITIONS. 93 

"ings, and all his poffible wants, as thofe natural 
"notices, and inftinctive cravings, which occur in 
"health, are now wanting, in confequence of the 
"depraved ftate of fenfation."* 

It was remarked before, when treating of the 
flow nervous fever, that, on the appearance of thofe 
fymptoms, which are, in general, fuppofed to be 
the harbingers of death ; defpair takes fuch ftrong 
poffeilion of the minds of the attendants, that it is 
with the utmoft difficulty the phyfician obtains 
thofe exertions, which may poffibly fave the life of 
the patient ; and which, being omitted, he well 
knows, his death will be inevitable. The caution 
given there, is equally proper in this place ; iince 
it too often happens in this fever, as well as in the 
former, that patients are loft for want of being, 
almoft momentarily, fupplied, with cordial and 
nouriftiing drinks : this omiffion proceeding from 
the attendants fuppofing thefe exertions to be ufe- 
lefs, and even cruel. Another reafon, often given, 
by thofe, who have neglected to make ufe of the 
neceffary means, is, the patient's incapability of 
iwallowing : when, perhaps, if the phyfician him- 
ielf Ihould make the trial, he would experience very 
little difficulty, in getting him to fwaliow a confid- 
erable quantity. To afcertain the caufe of this 

difference 

* Obfervations on the Difeafes of Seamen,, by Gilbert Blane, 
M. D. p. 398. 



94 MEDICAL ADMONITIONS. 

difference cf fuccefs, in the different attempts of 
the nurfe and the phyfician ; and to point out the 
proper method to be ufed in thefe fituations, will 

be at leaft proper to attempt. 

/ 

In tlie advanced periods of thefe fevers, the brain, 
and whole nervous fyftem, are in fo deranged a 
ftate ; that a flight IKmulous feldom excites the 
correfponding idea, which it was ufed to produce 
in health ; and, frequently occafions no impreflion 
at all. When a patient is in this ftate, the merely 
emptying a fpoonful of liquor into the mouth, is 
not fufficient to excite thofe mufcles into action, by 
which the act of fwallowing is performed ; the li- 
quid, therefore, remains in the mouth, until it 
efcapes out at the corner of the lips ; or elfe, from 
a drop infinuating itielf into the windpipe, the 
whole quantity, from the violence and fuddennefs 
of the irritation, is thrown forcibly out at the mouth 
and noftrils. The appearances, in either of thefe 
cafes, feem, at firft fight, to warrant the conclufion 
which is generally drawn from them, that the pa- 
tient has totally loft the power of fwallowing : but, 
if the patient be fo much aroufed from this deli- 
rious, or comatofe ftate, as to be apprized of the 
nature and intention of the endeavours that are 
making, he will generally be found ready enough 
to afTift them. After routing him, by gently fhak- 

ing, 



MEDICAL ADMONITIONS. 95 

ing, fpeaking to him, railing him in the bed, &c. a 
fpoon, filled with the liquor, that is intended to be 
given him, iliould he put to his mouth ; moving it. 
about againft the tongue, lips, and fides of the 
mouth, until he is difcovered to have fwailowed 
the few drops that have fallen from the fpoon. It 
now appearing, that the mufcles ferving to degluti- 
tion, are capable of performing their office, the 
whole quantity is to be poured into the mouth, and 
followed by as much more as may be thought ne- 
ceffary ; fince, after having been thus roufed into 
action, it will be fome little time, before they re- 
lapfe into their previous ftate of infenfibility. 

Another circurnftance alfo occurs, in the coma- 
tofe ftate of thefe fevers, from which the nurfes 
are too likely to form a prognoftic, which mull 
necefTarily confirm them in their defpondency j 
but this fymptom frequently is to be feen, without 
bearing that fatal import, which is commonly fup- 
pofed. Where death comes on flowly, and the 
natural actions flop gradually, fome little time be- 
fore life ceafes, the mucus or phlegm colle&s in the 
back part of the fauces, from the infenfibility and 
lofs of power in thofe parts, which, in health, ferve 
to expel it j and, by occafioning an interruption 
to the palfage of the air, in infpiration and expira- 
tion, a rattling noife is produced, which is termed, 

by 



Q6 MEDICAL ADMONITIONS. 

by the nurfes, the rattles. Whenever, therefore, 
this accumulation of phlegm, and confequent rat- 
tling, takes place, in any cafe, where the difeafe 
has continued for a little time; the good women, ex- 
peeling that death will foon follow, refolutely op- 
pofe the making of any attempts for the recovery 
of the patient, or the fupport of his ftrength. But, 
in the advanced periods of thefe fevers, this fymp- 
tom may frequently appear, without being accom- 
panied by that degree of danger, which is in gen- 
eral fuppofed : for a confiderable quantity of mucus 
is fecreted, at this time, by the glands, which are 
placed about the back part of the fauces ; and is 
there gradually collected, in confequence of the 
patient, from the difordered ftate of his brain, not 
experiencing any inconvenience from it ; and, 
therefore, employing no efforts for its removal. 

The mucus thus accumulated, and rendered ex- 
ceedingly tenacious, by the increafed evaporation, 
from the patient's breathing with his mouth open ; 
by obftruc~ting, and almoft clofing the pafTage, pro- 
duces the effect above mentioned. At the fame 
time, in confequence of this mode of breathing, 
the teeth, gums, and tongue become dry ; appear- 
ing as if covered with a dry, hard, and black 
varnifh, and feem to denote immediate diflblution. 
But it frequently happens, that if, inftead of aban- 
doning 



MEDICAL ADMONITIONS. §f 

doning the patient in defpair ; the neceffary exer- 
tions are made, the patient is raifed and fupported 
in his bed, the mouth and throat conftantly moif- 
tened by nourishing and cordial drinks, thefe fyiru> 
toms will foon difappear, and the patient probably 
recover. 

Prevention. The necelHty of conftantly 
ventilating the chamber of the fick, and of filling 
it with the fumes of vinegar, &c. to expedite the 
cure of the patient, has been already ftated. But, 
it is neceffary to be more particular on this head 5 
fince, by the proper management of fuch means, 
the fpreading of the infection to the attendants, 
the reft of the family, and even the neighbourhood, 
can alone be prevented. 

By the ingenious and affiduous enquiries of mod- 
ern phylicians, we have obtained confiderable~in- 
formation, as to, the nature of the contagion, which 
produces fever. They have even traced it to the 
fources, whence it arifes ; and have difcovered it 
in the miafma, or vapour riling from foul and ftag- 
nant waters, and from marfhy lands j in the efflu- 
via from an healthy body, which has been fuffered 
to accumulate in foul clothing, and clofe apart- 
ments -, and the effluvia arifing from the body of 
one affected with fever. 

N It 



98 MEDICAL ADMONITIONS. 

It lias been afcertained, by a variety of experi- 
ments, 

I. That various fubftances may become imbued 
with thefe effluvia, and retain them for a confider- 
able time. 

II. That thefe effluvia, fuffered to remain long 
at reft, in fuch fubftances ; not only retain their 
noxious powers unimpaired, but feem to poffefs an 
higher degree of virulence, and more aclive pow- 
ers, than thofe which arife immediately from an 
human body. 

III. That the fphere of action of thefe effluvia 
extends, but to a fmall diftance from the body, 
whence they arife ; or from the fubftance, in which 

they are contained. 

IV. That their power of communicating infec- 
tion, is leffened, in proportion, as they are diffufed 
through the atmofphere. 

V. That the fpace of time is very different, ac- 
cording to different circumftances, in which infec- 
tion manifefts its prefence, by any evident changes 
produced in the fyftem : thefe changes fometimes 
immediately following its introduction ; whilft, in 
other cafes, ten days or a fortnight will elapfe, be- 
fore its effects are difcoverable. 

VI. 



MEDICAL ADMONITIONS. 99 

VI. That infection, like fome other poifons, 
does not affect thofe who are accuftomed to it - 9 
especially, if it be gradually applied. Hence thofe 
about whom the poifon is generated, may be lefs 
fufceptible of injury from its influence : and phy- 
ficians and nurles efcape, while the vifitors of the 
iick, become infected. 

VII. That cold, which, in general, has been 
thought to have produced different effects, con- 
tributes to the increafe of infection, 

I am convinced, that, when you confider the 
dangers, to which the juftly celebrated phyficians 
muft have expofed themfelves, who have eftab- 
lifhed thefe facts, by experiments, and accurate ob- 
fervations ; you will readily allow, that the world 
is highly indebted to them, for their enthufiaftic 
exertions in the caufe of humanity j and will, per- 
haps, feel, with me, a confiderable regret, that any 
motive fhould induce an intelligent phyfician, to 
whom all this is known, to affert, in a popular 
work, that " very few of the valuable difcoveries 
" in medicine, have been made by phyficians : they 
"have, in generaj, been the effect of chance, or 
M of neceffity, and have been ufually oppofed by the 
"faculty, 'till every one elfe was convinced of their 
*' importance." 

Domeftic Medicine. Introducl. p. xxii. 

Such 



IOO MEBICAL ADMONITIONS. 

Such an accufation as this, unfupported by a 
tittle of evidence, cannot require a defence to be 
fet up againft it -> however much, it may merit a 
fevere comment. t 

But to return to that, which is of much more 
confequence. — We were remarking, that cold con- 
tributes to the increafe of infection. The import- 
ance of this obfervation to every family, and its 
contradicting the generally received opinion, de- 
mands, that the arguments advanced in its favour, 
by Dr. Blane, mould appear in his own words. — 
" Cold is favourable to infection, by preventing 
" ventilation ; for people exclude the air, in order 
" to keep themfelves warm ; and the poor, in par- 
" ticular, do fo, on account of their bad clothing, 
" and their not being able to afford fuel, to make 
"good fires. Heat is the great deftroyer of infection, 
il and feems to act by evaporating, and thereby 
" diffipating it ; and the effect of fires in apart- 
** ments, is to produce a conftant change of air ; 
" thereby preventing its ftagnation and corruption, 
" and the accumulation of unwholefome effluvia."* 

To leffen the probability of the contagion being 
diffeminated, all unneceffary intercourfe with the 
lick, mould be avoided : and in addition to the 
means already propofed, for-correcting the air of 

the 
* Obfervations on the Difeafes of Seamen, by Gilbert Blane, 
M. D. p. 250. 



MEDICAL ADMONITIONS. IOI 

the apartments, the mode recommended by Dr, 
James Carmichael Smyth, for obtaining the nitrous 
or marine acid, in a ftate of vapour, may be em- 
ployed. It confTfts in decomposing nitre, or com- 
mon fait, by means of heated vitriolic acid, which 
may be done, as follows.— Put half an ounce of 
vitriolic acid, into a glafs, or china cup, or deep 
faucer ; warm it, by placing it in heated fand, add- 
ing to it, from time to time, fome common fait. 
By a fimilar procefs, as fuggefted by Mr. W. Bliz- 
ard, Surgeon of the London Hofpital, " the kali 
" acetatum (diuretic fait, of the ftiops) being added 
" to the vitriolic acid, the acetous acid become* 
" inftantly feparated from its alkaline bafis, and 
" prefents itfelf, pungent, and refrefhing, in a de- 
" gree even beyond the foffil acids." * 

The neceffity of an attention to thefe admoni- 
tions, may be rendered, perhaps, more evident, by 
confidering ; that the effluvia exhaled from one 
perfon, during the night, will, in general, be found 
to be very pungent and difgufting, to any other 
perfon, who may enter his bed-room ; whilft the 
perfon, from whom they may have arifen, will 
hardly be fenfible of any particular odour. The 
fame is to be obferved of clothing ; iince the fmell 
proceeding from foul clothing, is often extreme- 

iy 

* Suggeftions for the improvement of Hofpitals, and other 
charitable Inftitutions, p. 54, 



J©2 MEDICAL ADMONITIONS. 

ly ofFenfive to others, whilft the wearer of them 
does not experience the lcafl inconvenience, The 
organs of fmell, in the perfon who generates thefe 
effluvia, being as little fufceptible of impreflion 
from their fenfible properties ; as his fyftem may 
be, from any peculiar virulence, they may pofFefs. 
Hence, much mifchief may arife ; fince a perfon 
may thus carry about with him, a matter not 
only highly ofFenfive to others ; but, perhaps, pof- 
fefling properties very dangerous to any other 
perfon, who may come within the fphere of its 
action : whilft he is himfelf unconfcious of its pof- 
fefling either of thefe active powers. 

Another caution, not in general fumciently at- 
tended to ; is to properly ventilate, and fumigate, 
the clothes, which had been worn by the patient, 
in the early days of the difeafe ; and which, being 
moll probably the fame which were worn, at the 
time when he was expofed to the influence of the 
contagious matter, may ftill retain a fufficient 
quantity of the poifon to communicate the difeafe. 

Great care is neceffary, in the management of 
the patient, even after the total removal of the 
fever. He will be now left in fuch a ftate of de- 
bility, that the flighteft exertions may prove too 
much for him : even the congratulations of his 
rejoicing friends muft be reftrained ; and great 

care 



MEDICAL ADMONITIONS. I&3 

Care be taken, that he be not exhaufted, by con- 
verfations with repeated vifitors. The food, which 
his returning appetite demands, perhaps with 
avidity, mould be given in fmall quantities, and 
frequently : and the quantity of his wine, as al- 
ready mentioned, mould be confiderably dimin- 
ished. Exercife mould be adopted, with the great- 
eft cate ; left too much fatigue be induced. Some 
caution, alfo, muft be employed, as to the expo- 
fure to the air, in guarding againft the cold, by 
proper clothing ; particularly j by the ufe of flannel 
next the fkin. Removal into the country, is gen- 
erally recommended to the convalefcent j but par- 
ticular care is neceffary, that he be not imme- 
diately fent to a fituation, in which the air is much 
colder, thart that from which he is removed ; left 
an inflammation of the inteftines, or lungs, be in- 
duced. 

Should any one have reafon to fuppofe, he has 
received the infection of this fever, from the ap- 
pearance of thofe fymptoms, which mark its com- 
mencement ; and particularly, from a difagreeable 
fenfe of finking and uneafinefs at the pit of the 
ftomach ; it will be advifable, as foon as poffible, 
to cleanfe the ftomach by an emetic, and to gently 
open the bowels ; immediately after which, fweat= 
ing may be promoted, by freely drinking white 

wine 



104 MEDICAL ADMONITIONS. 

wine whey. Should thefe means not prove fufEU 
dent, a blifter may be applied to the nape of the 
neck ; — or rather, if thefe fail, immediate applica- 
tion fhould be made, for the advice of the intelli- 
gent and experienced phyfician. 

By the late difcoveries refpe&ing the conftituent 
principles of atmofpheric air, phyficians have" been 
enabled to eftablifh certain principles, on which 
they can proceed with greater confidence, in the 
treatment of this, and many other difeafes. A 
knowledge of thefe difcoveries, and of their appli- 
cation by the healing art, cannot but be a pleafing 
and interefting acquifition to any one ; but it is 
more, — it is a branch of fcience, which fhould be 
generally known. The friends of the lick, pof- 
iefTed of this knowledge, and confequently apprifed 
of the principles, on which the phyfician proceeds 
to obtain a cure, can then more powerfully aid his 
endeavours : nor is this all — they alfo gain a know- 
ledge of the principles, on which they ought to 
proceed, for the prefervation of their own health. 
The Medical Extracts of Dr. Thornton communi- 
cate this information, in a moft pleafing manner. 
Medical men wifh not for ignorance, either in their 
patient, or his friends : they know, that whilft ex- 
ercifmg the duties of their profeffion, the know- 
ledge of the firft principles of medical fcience, will 

always 



MEDICAL ADMONITIONS. IO5 

always yield them the ftrongeft aid ; whilft igno- 
rance wilL beft provide the prey of the rapacious 
empiric. 

I have given a flight fketch of the principles, on 
which airs of different purity are employed in dif- 
ferent difeafes, whilft treating of Consumption. I 
fhall therefore, here, only introduce the evidence 
of the ingenious Rev. Joseph Townsend, author 
of the Guide to Health, &c. as to the ufe of vital 
air in this difeafe. "In my putrid fever, when- 
ever the air of my chamber was artificially oxygen* 
ated, as my phyfkian, Dr. Thornton, often witnef- 
fed, my refpiration was pleafant, my oppreftion at 
my cheft relieved, and I was enabled to breathe 
freely through the noftrils, without the afliftance 
of my mouth, which I could not do before the 
room was oxygenated. At the fame time, I am 
convinced that my appetite was greatly increafed* 
my occaiional fleeps rendered fotind and undiftur- 
bed, and my digeftion considerably quickened." 

On account of the comfort it muft yield to par-* 
ents, to learn that infants are not fo liable to fevers 
as adults, I fhall clofe thefe remarks on this fever, 
with the opinion of Dr. Underwood on this Cub* 

The Do&of has obferved, for" many years, as 

well in the hofpital, as in private practice, that in- 

O fants 



106 MEDICAL ADMONITIONS* 

fants do not readily take common fevers, though 
expofed, for a long time, to that contagion, which 
has appeared to affect adults around them. He alfo 
obferves, that every phyiician attending lying-in 
hofpitals, mull not only have known many infants 
fuckled, without injury, through the whole ftage 
of bad fevers, from which mothers have recovered; 
but alfo, in other inftances, fucking greedily within 
an hour or twO of their mother's death. 



REMITTING FEVER. 

Such fevers, as fufFer irregular abatements, or 
remiffions, of their violence* are termed Remitting 
Fevers. Remitting fevers hold a middle place, be- 
tween continual and intermittent fevers. Con- 
tinued fevers, in changing to intermittents, in gen- 
eral, take on the appearance of a remittent, before 
they clearly intermit. Intermittents, alfo, which 
are becoming continued fevers, have irregular re- 
millions, in the place of thofe clear interrniflions, 
which before charaderifed them. 

This, like other fevers, commences with a cold- 
nefs and fhivering ; accompanied by violent pains 
in the head, and back ; great dejection of fpirits, 
lofs of ftrength, and frequently a conliderable diffi- 
culty of breathing. Sicknefs at the ftomach, gid- 

dinefs, 



MEDICAL ADMONITIONS. 1 07 

dinefs, and frequent hiccups, fhew that the firft 
pafiages are charged with offenfive matters. The 
cold ftage is fucceeded by a confiderable degree of 
heat ; the pulfe, which in the cold fit was fmali 
and quick, becomes fuller, but abates not of its 
quicknefs. The pain of the head and back increafe ; 
and the naufea is augmented, until it terminates in 
copious vomitings of bile ; difcharges of bile, by 
ftool, alfo often take place. Thefe fymptoms con- 
tinuing fome time, the fkin, which had hitherto 
been dry and hot, becomes inoiftened with fweat ; 
which fometimes flows very freely. Soon after 
this, the fymptoms abate, fome cealing entirely, 
whilft others are much leffened ; the patient flat- 
tering himfelf with the hopes of health fpeedily 
returning ; but thefe pleafmg illufions, are foon 
diffipated, by a return of the paroxyfm ; which 
comes on with increafed violence. The diforder 
proceeds thus, the paroxyfms alternating with the 
remiilions, until the remiflions, which leflen each 
time, are, at laft, entirely loft \ the fever afluming 
a continued form. The difcharges now become 
very offenfive ; a conftant delirium and reftleffnefs 
takes place ; and, if the fever be not oppofed by 
means fufficiently powerful, ftartings of the ten- 
dons, profufe clammy fweats, and convulsions, come 
Gn ; which foon terminate in the death of the 
patient. 

In 



J08 MEDICAL ADMONITIONS. 

In the cure of this fever, one important indica- 
tion is, the removal of the accumulated bile ; but 
the fame motives, which have forbidden, the de- 
tailing of the mode of cure, in the other fpecies of 
fever, prevent its admiffion, in the prefent inftance. 
In this difeafe, the moft vigilant attention is re- 
quired ; nor will this be fufficient, unlefs united 
to fkill and experience. 

Early, regular afiiftance mould be procured, in- 
deed, in every cafe of fever ; but, in no cafe, is the 
watchful eye of the phyfician more neceflary, than 
in this : for if he be called early in the difeafe, and 
difcover the nature of the fever, which is, in gen- 
eral, fumciently apparent to the experienced ; he, 
by timely and well adapted evacuations, will re- 
move that accumulation of fordid matter, in the 
firft paffages j which, in the courfe of the difeafe, 
would be likely to occafion much trouble and dan- 
ger. As the difeafe proceeds, he will be enabled to 
afcertain the critical moment, when he may ven- 
ture on the free ufe of the bark ; the omiffion of 
which, might, moft probably, occafion the lofs of 
the patient ; or, if ufed incautioufly, would render 
every fymptom more violent ; and the difeafe, of 
courfe, lefs likely to be removed. Should fuch. 
circumftances occur, as may feem to forbid the ufe 
of this valuable medicine ; the intelligent phyfician 

will 



MEDICAL ADMONITIONS. ( I09 

will often be enabled, by a due attention to the 
rules of his art, to effecl: thofe neceflary changes, 
which will render the employment of it fafe and 
beneficial. 

Languor, naufea, giddinefs, and disinclination 
to motion, often precede, for fome days, the fhiv- 
ering, which introduces this fever. At this junc- 
ture, the adminiilering of an emetic ; and fome 
gentle medicine, to produce a difcharge from the 
bowels, would probably prevent the coming on of 
the fever j efpecially, if fucceeded by a proper ufe 
of the bark. 

By a regard to the rules, already laid down, the 
attendants on the lick, may derive fuificient in- 
ftructions for their conduct in the progrefs of this 

fever. 



HECTIC FEVER. 



In hectic fever, there are two evident exacerba- 
tions, in every twenty-four hours : one of thefe 
happens about noon, and continues the greater 
part of the afternoon, then fuffers a flight remif- 
iion ; as evening comes on, a frefli exacerbation 
takes place, which continues until after midnight j 
another remiffion taking place about two or three 
o'clock in the morning, about which time, or, in 

general, 



JIO MEDICAL ADMONITIONS. 

general, later, a profufe fweating alfo frequently 
comes on. During the feverifh ftate, an exceffive 
heat is felt, in the palms of the hands, and the foles 
of the feet. The urine is, in general, of a high 
colour, and depofits a bran-like fediment ; but of 
a reddifh hue. This fever is generally fuppofed to 
exifl only as a fymptom of fome other difeafe, and 
as a confequence of the injury of fome particular 
part. It moft frequently occurs, when a collection 
of matter has taken place. 

Since hectic fever is not a primary difeafe, I 
mould not have treated of it feparately, if I had 
preferred an attention to the rules of arrangement, 
to the important point of calling the attention par- 
ticularly, to that ftate I have juft defcribed ; which 
never exifts without danger ; and which is often 
to be found, where it has not excited the leaft 
alarm. 

Wherever this difeafe is met with, there may it 
be expected, that the fyftem is harrafled by fome 
local affection, of a dangerous tendency ; and if 
proper medical help has not been yet obtained, no 
time mould be loft, before application is made to 
fome one, to whom ftudy and practice have given 
acutenefs, in difcovering the difference of difeafes, 
as well as a knowledge of the moft judicious modes 
of treatment. 

INFLAMMATION. 



MEDICAL ADMONITIONS. Ill 

INFLAMMATION. 

INFLAMMATION, unlefs very trifling, is pre- 
ceded by a fenfe of coldnefs, and by fhivering t 
to thefe fucceed an increafe of the heat of the whole 
body, oppreffion, and thirft : the pulfe becoming 
full, hard, and quick ; and the urine high coloured. 
A fenfation of fulnefs and teniion, with a preter- 
natural fenfibility, is experienced in the part, which 
is the feat of the inflammation \ with a degree 
of heat, proportioned to the degree of the dif- 
eafe ; and a pulfatile, or throbbing pain, which is 
more or lefs violent, in fome cafes, than in others : 
the difference depending, in a great meafure, on 
the ftructure of the affected part. The blood vef- 
fels, as far as the inflammation extends, are dif- 
tended with blood : and thofe veffels appear to be 
filled with red blood, which, in a natural flate, do 
not appear to receive it at all, 

The blood, which is taken away in thefe difeafes ? 
is, when immediately drawn, of a dark colour j 
and in a more fluid Itate, than that which is taken 
away in health, or in thofe difeafes where inflam- 
mation does not exifl ; whilft coagulating, its fur- 
face is mottled with waves of a purpliih hue ; but 
as foon as the coagulation has taken place, the fur- 
face of the coagulated part becomes covered with 



112 MEDICAL ADMONITIONS. 

a buff cruft : but this appearance is not conftant j 
fince, though it might otherwife fhew itfelf, it may- 
be prevented, by certain circumftances in the tak- 
ing it from the vein, in the receiving it in the 
veffel, &c. 

Inflammation may terminate either by difper- 
fion, fuppuration, or mortification. 

Refolution, or difpcrfion, is faid to take place, 
when the cure is performed, while the texture of 
the part remains entire. This termination may be 
expected, when the difeafe is flight, and when 
proper means have been had recourfe to, in the 
early part of the difeafe. 

If the difeafe be violent, or fhould it not be op- 
pofed by means, fumciently powerful ; the pulfa- 
tile or throbbing pain increafes, with the other 
fymptoms, until fuppuration, or the formation of 
matter, takes place. This is known by the pain, 
heat, and rednefs abating : and, at length, by the 
difcovery of a fluctuation of a fluid, in the difeafed 
part. 

But fhould the difeafe have exifted a confiderable 
time ; and, inftead of yielding any of thofe appear- 
ances, from which we might conclude that fuppu- 
ration was about to take place ; the pain, heat, and 
rednefs fhould increafe to a confiderable degree ; 

it 



MEDICAL ADMONITIONS. Ilj 

it may then be feared, that the difeafe will termi- 
nate in a gangrene or mortification. When thy 
change is taking place, the Colour of the part, from 
a bright fcarlet, becomes a dark crimfoh ; blifters 
arife on the part ; the tumour fubfides, the part 
becoming foft and flaccid ; and from being vio- 
lently pained, becomes nearly irifehiiblel The deep 
red colour is now exchanged for a livid purple : 
the part at length becomes quite black, and having 
loft all life, exhales a cadaverous fmell ; and, if 
health fliould be reftored, is at laft thrown off by 
the action of the furrounding live parts. 

It cannot be neceiTary to be more particular, as 
to the terminations of inflammation : the defcrip- 
tion df tlie appearances which take place, on the 
feveral terminations jiift mentioned, may be, how- 
ever, highly ufeful ; fince, by ah attention to it, 
thofe who venture oil the dangerous practice of 
domeftic quackery, may be enabled to difcover 
when danger is threatened, in confequehce of their 
neglect, or improper interference. 

In every inflammation, there is an increafed ac- 
tion of the veffels of the part, and, indeed, of the 
heart itfelf, and of the whole fyftem of blood- 
veffeisn 



To 



114 MEDICAL ADMONITIONS. 

To effect the cure of inflammation, therefore j 
„ thofe means mould be employed, which are known 
to be effectual, in reftraining this inordinate action. 
Among the firft of thefe, may be reckoned bleed- 
ing. Blood, therefore, mould be taken away, in 
the firft place— — but, arrived at this point, how 
fhall I proceed ? Shall I attempt to furnifh the un- 
informed with particular rules, by which he fhall 
determine, as to the quantity of blood to be taken 
away, as to the mode in which it is to be drawn, 
&c. ? You muft plainly fee, that this ought not to 
be attempted ; and that 1 mould rather fay, that 
every cafe of inflammation, which requires general 
bleeding, muft be a malady of fo ferious a nature, 
as to demand all that art and fcience can perform. 
I mall, therefore, here only make fome general ob- 
fervations, on the means of cure : fhewing the 
many difficult and important points, in which an 
accurate decifion will be demanded ; and leave it 
to you, and the reft of my readers, to judge of the 
propriety of taking, without the beft advice, even 
this firft ftep, in the attempt to obtain a cure. 

In afcertaining the quantity of blood to be taken 
away, not only muft the fex, age, and ftrength, be 
confidered ; but alfo the degree of violence of the 
difeafe, and the importance of the part affefted, to 
the ceconomy of the fyftem. The quantity being 
determined on, it is next neceflary to afcertain, 

from 



MEDICAL ADMONITIONS. IIjJ 

from what part the blood lhall be taken. In fome 
cafes, where it is required, to produce a confidera- 
ble effect on the whole fyftem ; it may be taken 
from the moft convenient part, however diftant 
from the part affected : but where it is only necef- 
fary to leffen the quantity of the blood, determined 
into the difeafed part 5 topical bleedings mould 
be employed, as near as convenient to the inflam- 
mation. If topical bleeding be refolved on, the 
Situation of the difeafed part, and other circum- 
ftances, muff point out the mode j whether by 
opening a vein, near the part, or by the applica- 
tion of leeches, or by cupping. When it is deter- 
mined, as to the quantity, and the mode by which 
it is to be taken away ; it is neceffary to confider, 
in what fpace of time, the given quantity mould 
be obtained. In moft cafes, the evacuation mould 
be procured in as little time as poffible ; the more 
fpeedily the difcharge being made, the more con- 
fiderable, in general, being the curative effects : but 
in other cafes, if the blood be not taken away, with 
the utmoft flownefs and caution ; a fufficient quan- 
tity will not be obtained, to be productive of any 
real benefit. Nor is it a matter of trifling confe- 
quence, to afcertain whether a flight topical bleed- 
ing may be fufflcient, for the removal of the difeafe ; 
or whether a more large and general bleeding be 
neceffary : for, on the one hand, if too fmall a 

quantity 



Il6 MEDICAL ADMONITIONS, 

quantity be taken, the difeafe will not be removed \ 
and, on the other, from too large a quantity being 
taken away, there is danger of inducing other dif- 
eafes, more difficult of removal than the original 
complaint. 

One of the moft powerful means, next to bleed- 
ing, of relieving the overloaded veffels, and of lef- 
fening the difeafe, is the proper adminiftration of 
purgative medicines : but no fmall degree of judge- 
ment is neceffary, in determining what kind of pur- 
gative fhould be employed ; fince, in fonie cafes, 
thofe only mould be had recourfe to, as produce 
the leaft irritation ; fuch as manna, neutral falts, 
&c. whilft, in other cafes, thofe of the ftrongeil 
kind, fuch as calomel, fcammony, jallap, &c. muft 
be had recourfe to. This evacuation fhould not be 
perfifted in to the fame degree, in every cafe ; and 
there are cafes, where even greater relief will be 
experienced, by procuring an evacuation of a dif- 
ferent kind ; fuch as that by perfpiration, which 
will fometimes, Indeed, be productive of more ad- 
vantage than even bleeding itfelf. In thofe cafes, 
where fudorifics are employed, purgative medi- 
cines, any farther than juft to obviate coftivenefs, 
are ibmetimes, not only unneceffary, but even in- 
compatible with the ufe of fudorifics ; fince, by the 
neceffary fhifting of pofture, occafioned by their 
operation, there is a probability of giving a check 

to 



MEDICAL ADMONITIONS. Iiy 

to the flow of perfpiration ; and thereby occanon*- 
ing, an increafe of the original complaint. 

Neutral falts, vegetable acids, &c. are ufeful ; 
fince they appear to poflefs, a power of diminifhing 
the increafed action of the blood-veffels, and, confe- 
quently, the impetus of the blood flowing into the 
difeafed part. 

The external applications, which may be ufefully 
employed, in the cure of inflammation, are nume- 
rous, and mull be varied, according to what is 
pointed out by the different indications. Hot wa- 
ter, plain, or impregnated with the virtue of med- 
icinal herbs, or in the form of fleam^ will be ufeful 
in fome cafes ; whilft, in others, not only cold 
water, but ice itfelf, may be beneficially employed. 
Cataplafms alfo may be necefiary j and thefe may 
be fedative, or {Simulating ; relaxing, or conftring- 
ing ; as the cafe may require. Sometimes, particu- 
larly where the inflammation is deeply feated, or 
poffeffes any of the internal parts, the ufe of blis- 
ters becomes advifable. 

You may now expecl: me to proceed, in defcrib- 
ing the refpective cafes, alluded to ; and in laying 
down particular rules to guide you, in the choice 
of the feveral applications, jufl mentioned : but call 
your eyes, once more, on the foregoing enumera- 
tion of remedies j and then fay, whether the ufe 

. of 



I I 8 MEDICAL ADMONITIONS. 

of fuch various, and even oppofite means, mould be 
entrufted, in cafes of fuch importance, to thofe who 
are totally unacquainted, with the ftructure of the 
human body, with the various powers it poueffes, 
the energies with which it is endued, and the chan- 
ges it undergoes by difeafe. Be affured that from 
a want of knowledge of general principles, the moft 
dangerous miftakes may be made, in the feleclion 
of thefe remedies ; and that, in certain periods of 
the difeafe, the employment of fome of thofe means, 
which, in other ftages, might be fuccefsfully em- 
ployed, would certainly be followed by an increafe 
of the inflammation ; and, in many cafes, might 
occanon an immediate termination in gangrene. 

Not only is ikill required in appropriating the 
different remedies, to the different ftag'es of the 
difeafe ; but great nicety of judgement muft be 
exercifed, to enable the practitioner to adapt the 
remedy to the difeafe, whilft gliding from one 
ftage to another j fince each may depend on a con- 
trary ftate of the fyftem, and consequently, require 
an oppoiite mode of treatment. Thus in the early 
part of the difeafe, when it is poffible to carry it off 
by refolution ; and it is fafe and expedient, to pro- 
cure this mode of termination : cooling and difcu- 
tient applications muft be adopted : but if refolu- 
tion cannot be accomplifhed, emollient, and even 
ftimulating fomentations and cataplafms, muft be 

ufed, 



MEDICAL ADMONITIONS. 119 

tiled, to procure a fpeedy fuppuration, but, as foori 
as this procefs is completed, a change mull "again 
take place in the treatment. Another change muft 
follow, when the difeafe is likely to terminate in 
gangrene ; and the nature of the applications muft 
be determined, by the confideration, not only of 
the circumftances then obfervable, but of thofe alfo 
which have preceded ; both requiring to be weighed 
in the mind, with the greateft attention. 

Even the refolution, or cure of inflammation, in 
Its firhY ftage, fhould not be attempted, without 
fome confideration 5 fince there are often impor- 
tant advantages to be gained, by allowing the fup'- 
purative procefs to take place : fuch as, the remo- 
val of fome extraneous fubftance ; the prevention 
or removal of fome other difeafe ; the formation 
of a critical abfcefs ; and cafes alfo occur, where 
the means which would be required to be ufed, for 
the removal of the inflammation, would do more 
injury to the conftitution, than the permitting the 
inflammation to proceed to fuppuration. 

For obvious reafons, I mail not attempt to trace 
out a plan, by which you may be enabled to under- 
take the treatment of fo dangerous a ftate, as that 
which accompanies gangrene. Hoping that the 
formidable appearance which this malady aflumes, 
will be fufEcient to deter any one from prefuming 

■ to 



120 MEDICAL ADMONITION*.. 

to attempt its cure, unlefs pofleffed of the neceflary 
knowledge of the animal ceconomy ; and of the 
means, by which the morbid deviations, to which 
it is fubject, may be corrected. 

Lefs difficulty arifes, in the endeavour to lay 
down rules for the regimen and management of 
the patient ; as the general outline of that part of 
his treatment, which is more particularly the prov- 
ince o'f the nurfe and attendants, will be laid down 
by the phyfician or furgeon. In the early part of 
the complaint, when there exifts a probability of 
difmifling the difeafe, by refolution ; the utmoft 
affiduity mould be exerted, that the effects of the 
remedies which are adminiftered, mould be fec- 
onded, by avoiding or moderating thofe irritations, 
which are almoft conftantly applied to the fyftem. 
The increafe of heat, therefore, mould be -pre- 
vented, bv allowing the free accefs of cold air into 
the room ; but in many cafes, although it may be 
advifable that the patient breathe the cool air, yet 
it may not be proper, that it fhould come in con- 
tact with the furface of the body : this is more 
particularly the cafe, when the inflammation has 
attacked the internal parts, as the bowels. In 
thefe cafes, the body mould, therefore, be defended 
from the immediate action of the cold air. But al- 
though it be thus recommended to protect the 
body from the cold, yet great care mould be taken 

that 



MEDICAL ADMONITIONS. 1 2 J 

that this be not done in fuch a manner, as to allow 
the heat of the body to accumulate, except in thofe 
cafes where it is defirable to produce an increafe of 
perfpiration. The patient mould be kept perfectly 
Hill, iirice, by the action of the mufcles, the motion 
of the blood is accelerated. Great care mould be 
alfo taken, that the aliment be of that kind, which 
is leaft likely to irritate : confifting only of panada, 
fago, barley-water, ripe fruits, &c. Rigoroufly a- 
voiding all animal food, fpirits, wine, &c. even in 
the fmalleft quantity* In thofe cafes where the dif- 
eafe exifts, in any confiderable degree, all aliment 
mould, at leaft for a time, be entirely abftained 
from : the patient being, however", plentifully fup- 
plied with drinks, of the raoft fimple and watery 
kinds 5 as toaft and water, and mint or balm tea, 
to each of which may be added, as much of the 
juice of lemons or oranges, as may render them a- 
greeable to the palate. In fome cafes, indeed, where 
the vital powers are too much diminifhed, a more 
generous mode of living will be directed by the 
phyfician or furgeon : and this will be enjoined, 
not merely where it is wiihed to bring on the ter- 
mination by fuppuration ; but even, fometimes, in 
thofe cafes, where the cure or refolution of inflam- 
mation, in its firft ftage, is propofed. That the 
power of making fo nice, and fo neceffary a dif- 
crimination, as will be neceifary to enable an^ one 
(^ to 



122 MEDICAL ADMONITIONS, 

to point out the cafes, in which the one, or the 
other, of thefe modes fhall be adopted,.is not likely 
to fall to the lot,, at leaft, of ordinary domeftic prac- 
titioners, muft, I think, be allowed ; and is one 
proof of the impropriety of trufting the cure of in- 
ilammation in fuch hands. 

When the procefs of fuppuration is commenced, 
it will be neceffary to make fome variation in the 
patient's regimen. Broths, and even fmall quanti- 
ties of folid animal food, may, in moft cafes, be now 
permitted ; for the fake of fupporting the animal 
powers, and enabling nature to accomplifh the work 
fhe has begun. 

But when gangrene is about to take place, the 
utmoft caution is required, in determining on the 
moft proper regimen to be adopted : for although 
it frequently happens, that where gangrene comes 
on, the vital powers are much exhaufted, and that, 
of courfe, a cordial and invigorating regimen be- 
comes neceffary : yet it fometimes is- the cafe, that 
o-angrene is the immediate effect of violent action ; 
a difpofition to which ftill exifting in the fyftem, 
and rendering the ufe of ftimulating medicines and 
diet, likely to aggravate the difeafe. 

Prevention. It is neceffary, that thofe things 
be avoided, which experience teaches us has the 
power of producing fulnefs, and increafed action 



of 



MEDICAL ADMONITIONS. 123 

of the blood-veffels : fuch is the indulgence in full 
meals of animal food, ftrongly feafoned dimes, fpi- 
ceries, &c. and the abufe of fermented and fpiritu- 
ous liquors. Animal food mould, therefore, be 
taken in very fmall quantities ; and the meals be 
chiefly compofed of vegetable fubftances, to which 
variety may, in fome meafure, be given, by the dif- 
ferent modes of preparation : nor -ihould even 
thefe be taken in a greater quantity, than is juft 
fufEcient to fatisfy the demands of nature. Spirits 
muft, of neceffity, be entirely prohibited ; and wine, 
and all fermented liquors, taken very fparingly. 

Gentle exercife, which is likely, by promoting 
the excretions, to prevent the occurrence of pletho- 
ra, or fulnefs of blood, ihould be freely employed. 

If any particular part has been once attacked by 
inflammation, it will, for a confiderable time after, 
be much difpofed to fuffer a return of the com- 
plaint : to prevent this, belides adopting the advice 
already delivered, that particular part Ihould be de- 
fended from the partial a&ion of cold. If it be 
fome internal part that has been thus afFeded, the 
furrounding parts ihould be covered with flannel, 
which ihould be worn, with its rougheft fide im- 
mediately next to the fkin ; this will not only de- 
fend them from the action of cold, but be produc- 
tive of other beneficial effe&s, which, however, 
need not be here particularifed, * Among 



124 MEDICAL ADMONITIONS. 

Among the circumftances which ocgifion inflam- 
mation, particularly of the internal parts, is the 
too fudden tranfition to an atmofphere, differing 
much, in its degree of temperature, from that to 
which the perfon has juft before been expofed. 
This is indeed fo frequently the caufe of danger- 
ous difeafes, that it cannot but be beneficial to ren- 
der it an object of attention, and to point out the 
moft efficacious means of preventing its dangerous 
confequences. When the body has, by any means, 
fuch as the employment of violent exercife, or fit- 
ting in an heated room, acquired a great degree of 
heat, the blood, by its rarefaction, has its volume 
enlarged ; and an increafed action in the veffels 
takes place. If, whilft in this ftate, the body be 
fuddenly expofed to the cold, the veffels on the fur- 
face become conftricted, and the blood is repelled 
into the internal parts ; where, mould any exciting 
caufe happen to be prefent, a congeftion and inflam- 
mation in fome of the vifcera may be the proba* 
ble confequence. 

After having been thus expofed to. the action 
of cold, at a time when the body was heated be- 
yond its natural ftate, the object, of endeavour 
mould be, to regain a regular circulation of the 
blood ; but, unfortunately, it often happens, that, 
not only the means adapted to the indication are 
omitted ; but that other means, which are moft 

likely 



MEDICAL ADMONITIONS. 1 25 

likely to aggravate the injury, are had recourfe 
to : fuch is the ufe of fpirituous liquors, which, at 
thefe times, by their ftimulus applied to the ftomach 
and bowels, already in a ftate verging on inflamma- 
tion, muft frequently produce thofe evils which they 
were intended to prevent. 

Another miftake is too frequently made, in hav- 
ing recourfe to fpirkuous liquors, and heating 
drinks, previoufly to the expofure to cold air £ 
thefe, by their flimulus, increafe the action of the 
blood-veffels of the vifcera, and difpofe them to run 
into difeafed action ; when, by the application of 
cold to the furface, immediately after, the blood is 
driven inwards. 

Having pointed out the mifchiefs likely to arife 
from the meafures generally adopted, to prevent ill 
confequences from the expofure to cold, whilft the 
body is heated ; I fhall endeavour to lay before 
you, the moft proper mode to be employed. 

Suppofe, then, any one, after having been for 
fome time in a heated room, is expofed to the 
cold air of the evening j or that after being heat- 
ed by walking, or other exercife, he is expofed to 
a current of cold air, or fits for fome time in a cold 
and damp room ; and that a confiderable chill, or 
a fenfation of extreme coldnefs, feems to pervade 
the whole body : in this cafe we may conclude, 

that 



126 MEDICAL ADMONITIONS. 

that only the addition of fome exciting caufe is 
neceffary, to occafio*i inflammation of the lungs, or 
of fome other important part ; and therefore, 
fhould immediately proceed to endeavour, at ob- 
taining an equable ftate of the circulation. This 
will be beft done, by a very gradual expofure to an 
atmofphere of a higher temperature ; gently exer- 
cifing the body, and drinking of fome warm, weak 
liquor, as weak wine and w r ater, gruel, or barley- 
water, until an agreeable warmth returns. If any 
fhivering has been experienced, it may be neceffary 
to lay down between blankets, and drink warm, 
diluting liquors, until a moifture is produced on 
the fkin. Should any flight pain or uneafinefs be 
felt, this treatment becomes the more neceffary, 
and fhould be continued, until that fymptom no 
longer exifts. 

Nearly equal danger arifes, from too fuddenly 
pafling out of an atmofphere of a very cold tem- 
perature, to one of a much warmer. Impelled by 
a defire to get rid of the difagreeable, and even 
painful fenfations, arihng from expofure to fevere 
cold, thofe who have been thus expofed, generally 
feek the warmeft room, and the neareft place to 
the fire ; and, not unfrequently it happens, that in 
addition, to drive out the cold more completely, 
fpirituous and other heating liquors are alfo had re- 

courfe 



MEDICAL ADMONITIONS. I2J 

courfe to. Should a chillinefs continue after this 3 
the fire is increafed, and a more free potation of 
fome fpirituous liquor is indulged in. By this con- 
duel, inflammation of the bowels, ftomach, or lungs, 
is frequently occaiioned ; and, indeed, it is feldom 
that it is adopted, with entire impunity ; fince a 
catarrh, or, as it is commonly called, a cold, moft 
commonly, at leaft, fucceeds. 

As to procure a compliance with advice, it is 
neceffary to fhew the reafons on which that aclvice 
is founded j I muft inform you, that after expo- 
fure to the cold air, efpecially for any confiderable 
length of time, the body is in a ftate moft highly 
fufceptible of injury from the application of heat. 
This takes place on the fame principle, that when 
the eyes have been fecluded fome time from the 
light, they will, on its being again admitted, be 
ftruck by the appearance of extraordinary fplen- 
dour ; and, that the hand will be more fenfibly af- 
fected, on Being plunged into a veffel of warm 
water, if it have been previoufly held in cold 
water, or fnow. 

A very little confideration will be fufficient to 
convince you, that, during this ftate of the fyftem, 
the expofure to fuch powerful ftimulants, as the 
heat of a large fire and ftrong drinks , muft be 
highly dangerous i and that, after expofure to fe- 

vere 



128 MEDICAL ADMONITIONS. 

vere cold, it is beft to pcrfift, for a little time, in 
fome gentle exercife ; to approach the fire very 
gradually, and to drink only of fome diluting^ 
weak drink, fuch as tea, barley-water, milk and 
water, &c. always remembering, that, when the 
body has been either chilled, or much heated, that 
it be brought back to its natural warmth by degrees. 

I cannot here refrain from recommending to 
your attention, an excellent little pamphlet, by 
Dr. Beddoes, entitled, A Guide for Self-Preferva- 
tion ; and I doubt not, but on perufing it, you will 
join with me in wifliing for its general circulation ; 
efpecially among the poor, for whom, by its price, 
and by the ftyle in which it is written, it is evident 
that it is benevolently intended. 

Of fo much real importance is it to flop the 
career of inflammation, at its very outfet, that I 
earneftly requeft you, in every cafe in which pain oc* 
curs with fever •, to obtain immediately the beft advice : 
remembering, that if inflammation be fuffered to 
proceed a certain length, although not fo far as to 
endanger the patient's life ; it is very probable, 
that it may be productive of very ferious incon- 
veniences, which he may be obliged to fuffer the 
remainder of his life. 



INFLAMMATION 



MEDICAL ADMONITIONS. 129 

Inflammation of the brain. 

In this difeafe, there exifts a very confiderabk 
degree of fever, a violent and deep-feated pain in 
the head, a fulnefs of the vefffels and rednefs of the 
face, and of the eyes : with exceffive dry fkin, and 
parched tongue. The patient obtains no fleep, is 
very much affected by the leaft noife, or the admif- 
lion of light into the bed-room ; and, generally, a 
Very high and furious delirium occurs. This dif- 
eafe foon runs through its courfe ; and, if proper 
means are not. had recotirfe to very early, the pa- 
tient will be loft within a very few days. 

Whatever irritates the membranes invefting the 
brain, or ftimulates the fubftance of the brain itfelf, 
may become an exciting caufe of inflammation of 
the brain : among thefe caufes, the inoft frequent 
are, external injuries, the drinking of large quan- 
tities of fpirituous liquors, violent exertions of the 
mind, and the expofure of the bare head to the 
ardent rays of the fun* 

Large and repeated bleedings, cathartics', and 
blifters, with the other remedies enumerated in 
the fection of general inflammation, will be em- 
ployed by the phyfician in this dreadful difeafe. 
The regimen will, at the fame time, be ordered to 
be as fpare as pofiible. 

R Te 



130 MEDICAL ADMONITION?. 

To enlarge on the means of cure adapted to this 
difeafe, and on the management of the patient, 
would be to engage the reader's time, without a 
poffibility of yielding him any ufeful information : 
fince, in a difeafe which is fo rapid in its progrefs, 
and is fo frequently fatal in its termination, no 
confideration whatever, mould induce any one to 
attempt its cure, unlefs he poffeffes real medical 
knowledge. Befides, fome of the fymptoms of 
this difeafe, are frequently to be met with, accom- 
panied by circumftances of fo ambiguous a nature ; 
that, unlefs the obferver has difcernment fufficient 
to enable him to mark the real ftate of the fyftem, 
his well intended exertions may foon deflroy his 
Unfortunate patient. 

Thofe, whofe nervous fyftems have been debil- 
itated, and whofe conftitutions have been impaired, 
by the frequent ufe of fpirituous liquors, are very 
fubjecl to be attacked with a fever, which is accom- 
panied with a delirium, fimilar to that which has 
been juft defcribed : the fever beginning its attack, 
with fymptoms, which feern to point it out to be 
of an inflammatory kind : but the exceflive debility 
which, in general, takes place in a day or two, 
plainly fhews ; that the adopting, in this cafe, the 
profufe evacuations required in the true and fimple 
inflammation of the brain, muft be fucceeded by 
the deftruction of the patient. 

INFLAMMATION 



MEDICAL ADMONITIONS. l$l 

INFLAMMATION OF THE EYE. 

This difeafe begins with a flight rednefs of that 
part, which is termed the white of the eye ; as this 
gradually increafes, the eye becomes hot, feeling 
as though particles of duft were on its furface. 
The eye-lids fwell, and the admifiion of light to 
the eye is accompanied with great inconvenience. 
Tears flow from the eyes in conflderable quantity, 
almoft fcalding the cheeks as they trickle down. 

By the ufe of well adapted remedies, at, and be» 
fore this period of the difeafe, a refolution of the 
"inflammation will generally be procured. 

But when the difeafe is neglected, or not oppofed 
by means fufficiently powerful j the rednefs increafes 
to fuch a degree, that the part of the eye which 
was before white, becomes of an uniform crimfon 
colour : the blood-veflels being fo diftended, that 
the furface becomes rough and irregular ; and fo 
much elevated, that the cornea, or tranfparent 
membrane, on the fore part of the eye, appears to 
be funk. The pain extends to the bottom of the 
eye ; and conflderable pain is alfo felt in the head. 
When the difeafe has proceeded thus far, it feldom 
goes off without leaving a fpeck on the cornea, 
which fometimes deprives the patient of his fight : 

fometimes, 



1^2 MEDICAL ADMONITIONS. 

fometimes, alio, a fuppuration takes place in the 
eye itfelf, which is fucceeded by total blindnefs ; 
the eye, in fome cafes, finking in the focket ; and, 
in others, being fo enlarged, as not to be contained 
within the eye-lids. 

The occafional caufes of this difeafe may be, 
external violence, applied to the eye-lid, or the eye 
itfelf. Extraneous bodies under the eye-lids ; fuch 
as particles of dufl, or fand ; acrid fluids, or vapours, 
&c. Expofure of the eyes to a ftrong light, and 
much exercife of the eyes in viewing minute objects, 
Inflammation of the eyes may alfo be the confe- 
quence of morbid acrimony, exifting in the fyftem : 
it may likewife accompany other difeafes of the 
eyes, and of the neighbouring parts j fuch as the 
turning inwards of the eye-lids ; ftithes, or ftyes, 
which grow on the eye-lids, and which may be 
either encyfted, fcirrhous, or w r arty ; tetters, and 
ulcerations on the edge of the eye-lid j and a great 
number of other difeafes, which it is unneceffary 
to enumerate here. 

When this difeafe is fimple, in no very confid- 
erable degree, and the exciting caufe no longer 
exifting, attempts for its cure may be made, by 
applying leeches to the temple, on the fame fide 
with the affected eye, in a number proportioned 
tq the age and ftrength of the patient ; a blifter 

may 



MEDICAL ADMONITIONS, 13^ 

xnay be applied on the temple, after the bleeding- 
has ceafed, and a briik purgative alfo be given, ufing 
for a lotion fimple rofe- water, or about four grains 
of white vitriol, dilTolved in two ounces of rofe or 
elder flower water. 

The defending of the eyes from the light, is a 
eircumftance of no fmall importance ; the follow- 
ing obiervatiqn, therefore, mould be carefully at- 
tended to. The difeafed eye, however clofely 
fecluded from light, will always be injured by th« 
action of light on the found eye ; fince each eye 
will fympathife with the other, in all its motions. 
The patient mould, therefore, confine himfelf to a 
dark room ; as he need not then keep oiF the cold 
air, by thofe means which he mull otherwife ufe 
for excluding the light. Should the difeafe not be 
conliderably diminimed, by the ufe of thefe means, 
application for regular afiiftance mould be imme- 
diately made : fince we may now conclude, the 
difeafe is fo obftinate, that mould time be wafted 
f)y the employment of unmccefsful meafures, or 
mould the family practitioner be led unfortunately 
to adopt flronger means, there will be danger, that 
his temerity may be punifhed by the poignant 
reflection, that, by his well meant interference, he 
has deprived his unfortunate patient of fight. The 
alarm, which undoubtedly I mean to excite here, 
will not, I am confident, be efteemed unnecefTary ; 

when 



134 MEDICAL ADMONITIONS. 

when the delicacy and - importance <ff the affected 
organ, the numerous intricate caufes on which the 
diieafe may depend, and the mocking manner in 
which it may terminate, be attentively confidered. 

The divifion of the inflammation into external 
and internal, is of confiderable importance to be 
attended to in this place. From an inability to 
make a diftinclaon between thefe, arifes the greateft 
danger of the uninformed practitioner occahoning 
total blindnefs to his patient : fince the inflamma- 
tion of the deeper feated parts of the eye may occur, 
without the appearance of fuch external figns, as 
will point out to him the great danger which 
exifts. Means, therefore, may be adopted, propor- 
tioned only to the external appearances ; and the 
fight, be irretrievably loft, in a very few hours. 

I am aware, that you will think, I ought to have 
particularifed a few other lotions, on the fuppofi r 
tion, that the lotion I have mentioned above mould 
not prove ufeful. Jkit as the difference of irrita- 
bility of the eye, in various cafes ; and the different 
degrees of the difeafe, mint determine the ftrength, 
and the nature of thefe applications ; it would be 
unfafe to offer any more definitive directions, than 
that care mould be taken, that none be ufed of fuch 
ftrength, as to occafion any increafe of pain. It is 
true, that fome very celebrated furgeons, recom- 
mend 



MEDIAL ADMONITIONS. ' 135 

mend the ufe of fuch remedies as occasion, for a 
time a very coniiderable augmentation of the pain : 
but applications of this kind muft be ufed, with 
the greateft circumfpe&ion ; lince, mould they fail 
of their wifhed for effect, they cannot but be likely 
to increafe the complaint.* There are few families 
who do not poffefs fome lotion for the eyes, which 
they recommend, as adapted for almoft every di£ 
eafe, to which the eyes are fubjeft : but certainly* 
when the various caufes of this difeafe, and the 
vaft number of its fpecies and varieties, are con- 
fidered, as well as the many affections of the fyftem 
with which it may be intimately conne&ed ; every 
one muft be fatisned, that there is no one remedy 
whatever, which can be had recourfe to indifcrim- 
inately, in all thofe cafes, without frequently pro- 
ducing confiderable mifchiefs* 

Even in thofe cafes, which are not diftinguiihedi 
by any alarming fymptoms 5 and in which the piai- 
dence of the family practitioner, induces him to 

make 

* Mr. Ware, in his ingenious publication, on the Difeafes of 
the Eye, recommends the dropping of the Thebaic tincture into 
the inflamed eye. In the hands of this gentleman, and of many 
other furgeons, this has proved a very powerful remedy : but 
when ufed by thofe who are not able to make the neceffary di£ 
crimination, between fuch cafes in which it may be ufed with 
benefit, and others in which it may prove injurious, very ill 
confequences may be produced. 



t$6 MEDICAL ADMONiffcONS. 

make ufe of only the mildeft applications, ill con- 
fluences may be produced by domeftic tamper- 
ings : fdr frequently, when the difeafe, though 
&ot violent, does not yield to the endeavours which 
are made, the veflels, from the mere duration of 
the inflammation, lofe their tone ; and hence is 
produced an additional caufe of the continuance of 
the difeafe, and that in one of its moil obfiinate 
ftates. 

In many cafes, the difeafe is fupported by an af- 
fection of the whole fyftem, the nature of which 
may be with difficulty difcovered ; but until this 
be done, and the fault of the habit corrected, no 
topical applications can be of arty fervice. 

Newly born, and very young children, are fubject 
to a fpecies of inflammation of the eyes, which ve- 
ry frequently, for w T ant of proper and timely help* 
produces blindnefs. It begins with rednefs and 
fwelling of the eye-lids ; the fwelling foon becomes 
fo confiderable ? that the eye can hardly be feen, 
even when force is made ufe of for their feparation. 
This is foon fucceeded, by the formation of a very 
confiderable quantity of a thick yellow matter, 
which is diffufed between the eye and eye-lids ; and 
which oozes out very freely, on the leaft preflure. 
This difeafe will oftentimes, if proper means are 
not timely ufed, continue a confiderable time j the 

eye-lids 



MEDICAL ADMONITIONS. 1 §j 

eye-lids remaining fo fwelled, for many days, that 
the real flate of the eyes cannot be difcovered : and 
frequently it happens, upon the fubfiding of the 
fwelling, that the diftrefled parents difcover, too 
late, that, in confequence of their neglect, or im- 
prudence, their unfortunate child is irremediably 
blinded. From that wonderful infatuation, by 
which the difeafes of children are delivered over to 
the management of ah ignorant nurfe, this melan- 
choly cataftrophe, in general, proceeds, Thofe' 
who have the opportunity of making the obferva- 
tion, know, that even among the middling clafs of 
people, application for regular aid is very feldoni 
made, even in this dreadful malady, until the difeafe 
is fo far advanced, as to render a melancholy ter- 
mination moll probable. 

You will not wonder, that I dare not prefume 
to recommend any plan for general adoption, in 
fo diilrefsful a cafe ; indeed the oiily advice that 
can be given, in fuch a work as this, is to make the 
earlieft application to fome experienced furgeon^ 
and to pay the moil implicit attention to his di- 
rections. 

As to the prevention of inflammation of the eyes> 

the following cautions may be ufeful. When the 

eyes are difpofed to be eafily inflamed, a long and 

earneft exercife of them ihould be carefully avoided. 

' S Caution 



138 MEDICAL ADMONITIONS* 

Caution mould be ufed, not only in viewing highltr 
illuminated and vivid objects as little as poflible ; 
but even long poring on duller objects, fhould be 
avoided. Acrid fumes and vapours are very hurt- 
ful ; and perhaps few more fo, than the fmoke of 
tobacco. Difcharges, to which the conftitution 
has been long accuftomed, mould not be unadvis- 
edly fuppreffed ; and where there is evidence of the 
exiflence of any particular acrimony in the fyftem, 
that mould be corrected ; and until that is accom- 
plifhed, a purulent difcharge mould be obtained 
from behind the ears, the pole of the neck, or 
from fome part, as near as can be conveniently had 
to the head. 



THE QUINSEY, or SORE THROAT. 

Of this troublefome, and fometiines dangerous 
complaint, there are five diftinct fpecies ; which 
often require a considerable degree of penetration 
and experience in the obferver, to enable him to 
afcertain the nature of the difeafe, or the part in 
which it is fituated ; both which circumftances are 
abfolutely necenary to be known, before any 
attempts are made for the cure. 

INFLAMMATION 



MEDICAL ADMONITIONS, I39 

INFLAMMATION OF THE TONSILS, 

OR THE 

INFLAMMATORY SORE THROAT. 

At the poftcrior part of the infide of the mouth, 
may be perceived two round glandular fubftances £ 
which are termed, the tonfils : between thefe is ex- 
tended a membranous fubftance, called the veil of 
the palate, from the middle of which is fufpended 
the uvula, a flefhy fubftance, in general about half 
an inch in length ; but varying much in ftze in 
different perfons, and in the fame perfons, at dif- 
ferent times. In thefe parts, is this difeafe in gen- 
eral feated ; and is difcoverable by the exiftence of 
fever, with rednefs, fwelling, pain, and a fenfe of 
tightnefs in thofe parts, accompanied by a difficulty 
in performing the action of fwallowing. 

The commencement of this difeafe is, in general, 
marked with a fliivering, and is fucceeded by febrile 
heat j as this heat increafes, the fkin becomes dry 
and parched ; and the pulfe becomes quicker and 
flronger than natural. Soon after, or imme- 
diately at the coming on of thefe fymptoms, an 
uneafy fenfation is felt in the throat, with a diffi- 
culty of fwallowing. A confiderable flow of'vifcid 
faliva takes place ; which, from the uneafinefs pro- 
duced by the attempts to fwallow it, is fuffered to 
accumulate in the mouth j occafioning no fmall 

inconvenience 



I40 MEDICAL ADMONITIONS. 

inconvenience to the patient. When the difeaie 
exifts in a high degree, the power of fwallowing is 
almoft loft j the liquids, which the fuffering patient 
attempts to force down, being thrown back from 
the mouth, or, in confequence of a drop falling into 
the windpipe, is thrown out with violence, both 
at the mouth and noftrils. 

This difeafe generally terminates, either by refo- 
lution, or fuppuration ; gangrene hardly ever tak- 
ing place. 

Among the caufes of this difeafe, may be men* 
tioned the expofure to violent degrees of heat or 
cold ; particularly the fudden expofure of the body* 
when much heated, to exceflive cold, or the partial 
application of a ftream of cold air ; indulgence in 
fpirituous liquors, and highly feafoned dimes ; eat- 
ing heartily of animal food, without a due mix- 
ture of vegetables j &c< 

Thofe who arc moft liable to this difeafe, are the 
middle aged, and thofe of a full habit. It is moft 
frequently to be obferved, in thofe feafons, when 
vicifiitudes of heat and cold chiefly occur. The 
having once been affected with this difeafe, leaves 
a ftrong difpofition to future attacks, 

For the removal of this difeafe, evacuations, by- 
Heeding and cathartics, mult be adopted j and other 

cooling 



MEDICAL ADMONITIONS, 144 

cooling means rauft alfo be employed. The extent^ 
to which thefe are to be ufed, is only to be after- 
tained, when a judgment is formed of the degree 
to which the impending difeafe might be likely to 
attain. Of this, a fkilful phyfician will, in general, 
be able, by a careful attention to the particular ap- 
pearances of the difeafed parts, the ftate of the pulfe 9 
the temperament of the patient, &c. to make a con- 
jecture fufficiently near the truth to enable him, 
if called in on the firft hours of the difeafe, to dif- 
perfe the inflammation, without any evil confe- 
quences. Since it is obvious, that to do this s 
requires both penetration and fkill, few furely will 
be found hardy enough to make this attempt, with- 
out poffeffing thefe indifpenfible requifites. 

If another argument were neceffary againft do-* 
meftic practice in this difeafe, it is to be found in 
the difficulty which the unexperienced muft find in 
always afcertaining the nature of the difeafe ; thus 
an appearance will frequently take place, which 
might induce any one, who is not accuftomed to 
obferve the difeafe, to fuppofe it of the ulcerated 
kind. ■ The appearance alluded to, is produced by 
feveral little openings or pits in the tonlils, which 
being filled with mucus, are very likely to be mif- 
taken for incipient ulcerations. A miftake pro- 
duced by this circumitance, would be of a very 

ferious 



142 MEDICAL ADMONITIONS. 

ferious nature ; fince it muft lead to a mode of 
treatment oppofite to that which is really indicated. 

Confiderable diftrefs is fometimes occafioned, by 
the inflammation fuddenly quitting the throat, and 
attacking fome important part, frequently the lungs. 
Much circumfpection and attention is neceflary, in 
this cafe, even from the moft experienced ; and 
the domeftic practitioner mould be appriled, that 
the greateft danger may follow this change, if not 
difcovered fufficiently foon to allow the early em- 
ployment of the neceffary means. 

With refpecl to the regimen of the patient, it 
muft be of the moil cooling and diluting kind. 
Barley-water, rendered agreeable to the palate by 
the addition of black or red currant jelly j linfeed 
tea, fweetened with honey, &c. may be ufed for 
common drinks : but the directions of fome one, 
who is well verfed in the nature of the difeafe, will 
be needed, for particular directions in this refpecl ; 
fince the regimen which is proper, whilft there are 
hopes of difcufling the inflammation, may require 
to be altered, when fuppuration appears to be about 
to take place. 

The patient is, in a great meafure, obliged, by 
the inconveniences he fuftains, to breathe with his 
lips open j in confequence of which, the moifture 

evaporating 



MEDICAL ADMONITIONS. 143 

evaporating from the inflamed furface, leaves it 
parched and dry j a ftate favourable neither to di& 
cuffion nor fuppuration : to remedy this, he mould 
conftantly hold fome fluid in his mouth. Although 
attempts to fwallow are accompanied with confide 
erable pain, he fhould frequently get down fome 
lubricating drink ; remembering, that the pain con- 
fequent to fwallowing is produced, not fo much by 
the paffage of the liquid which is fwallowed, but 
by that action of the inflamed parts, by which 
deglutition is performed : hence as much pain is* 
in general, produced by fwallowing a tea-fpconfui 
of any liquid, or even the faliva, which fo con-* 
ftantly demands deglutition, as would be occa- 
fioned by fwallowing a much greater quantity $ 
wherefore the patient fhould, by trials, difcover 
nearly the quantity which can be thrown down at 
each exertion, and then never make the attempt 
with a lefs quantity. 

Gargles are frequently of the greateft ufe in this 
complaint ; but the ingredients, of which they are 
eompofed, mlift be pointed out by the degree and 
ftate of the difeafe. 

Bathing the feet in warm water, oftentimes 
gives great relief, when the fwallowing is difficult. 
Similar benefit has been experienced from the fteam 
of warm water, received in the mouth, through a 
funnel, or fome proper apparatus, External 



144 MEDICAL ADMONITIONS. 

External applications are frequently of the great= 
eft fervice. In the advanced ftage of the difeafe, 
emollient cataplafms applied to the neck and under 
the ears, contribute much to the relief of the 
patient. But the moft evident advantages, refult- 
ing from the ufe of external remedies, are thofe 
which are produced by the ufe of flimulating appli- 
cations, fuch as hartfhorn and oil, cataplafms of 
oatmeal and flour of muflard, blifters, &c. applied 
to the neck, when the patient firft difcovers any 
uneafinefs in the throat ; for frequently, as foon as 
thefe applications have excited a heat and rednefs 
externally, the internal inflammation will begin to 
leiTen. 

For the prevention of this difeafe, the directions 
fhould be adverted to, which have been already 
given, when treating of inflammation in general 5 
particularly attending t6 the admonition, of defend- 
ing the external furface over the part which is dif- 
pofed to inflammation, by additional covering ; and 
with fuch fubflances neareft to the Ikin, as may, by 
gently irritating it, promote the a&ion of the vef- 
Jfels on the furface. 



THE 



MiiCicAL admonitions, 145 

tfffi tUf RID OR MALIGNANT ULCER- 
ATED SORE THROATi 

In this difeafe, the tenuis, and att the internal 
fauces, are affe&ed with rednefs, fwelling, and gan- 
grenous ulcers, producing a difficulty, both in fwal- 
lowing and breathing, accompanied by a fever of 
the putrid kind* 

This difeafe begins, in general, With frequent 
chills and fhiverings, exceffive languor, depreffion 
of fpirits, with continual naufea, and frequent urg- 
ings to vomit. Thefe are fucceeded by a febrile 
ftate, in which the pulfe is quicker and fmaller than 
natural : at the fame time, the patient becomes 
fenfible of a ftiffnefs of the neck, with a roiighnefs 
and heat in the throat, refeifoblihg the fehfation 
produced by the application of pepper; Soon after- 
wards, a fearlet eruption is thrown out on the Ikin* 
firft on the face and neck, and then over the whole 
body 1 hd extremities. The back part of the infide 
Of the mOuth, the uvula, tonfils, &c. upon infpee* 
Hon, appear red, and a little fwelled, and then fev- 
eral fpots appear on the parts juft mentioned, of a 
grey or afh colour ; the voice becomes particularly 
hoarfe and rough, and the pulfe quicker and fmaller* 
As the fever increafes, thefe fpots extend themfdves * 
in proportion to the violence of the difeafe 5 fre- 
quently fpreading and running one into the other, 
T with 



I46 MEDICAL ADMONITIONS. 

with the utmoft rapidity, the debility becoming 
exceflive, and a continual difcharge of a thin acrid 
humour taking place from the nofe and mouth, 
corroding both the lips and noftrils. As the dif- 
eafe proceeds, the greyifh crufts are difcovered to 
be deep gangrenous floughs, beneath which the 
parts are undermined to a vail extent ; the breath 
becomes exceedingly offenfive, and the difeafe foon 
increafes to fuch a degree, unlefs happily oppofed 
by fuccefsful means, as to carry off the patient, 
fometimes within the third day of the difeafe. 

From this flight Iketch, the domeftic practitioner 
niuft be apprifed of the malignity of this difeafe, 
and the rapidity of its progrefs ; and he may alfo 
be auured, that he will not always be able to dif- 
tinguifli it, at its firft attack, even from the inflam- 
matory fore throat, juft defcribed 3 it fometimes 
requiring a very careful inveftigation, before the 
real nature of the difeafe can be afcertained. A 
miftake here would not only occafion an omiflion 
of the proper remedies, but the employment of 
fuch means, as mud neceflarily very much expe- 
dite a fatal termination of the difeafe. For the 
evacuations which would be requifite in the cure 
of the inflammatory fore throat, cannot fail but fo 
to reduce the patient, if employed in this difeafe, 
that no fubfequent endeavours might be fuflicient 
$0 fave him. The operation of a fmart dofe of 

phyfic 



MEDICAL ADMONITIONS. I47 

phyfic would be fometimes fufficient to fink a 
patient irrecoverably. 

The endeavours of the phylician will be, to fup- 
port the ftrength of the patient, oppofe the feptic 
tendency of the whole fyftem, and leffen the effects 
of the acrid matter poured out upon the fauces. 
In accomplifhing thefe intentions, the phylician 
muft depend on the affiduity and zeal of the attend- 
ants : if their exertions are not regular and unre- 
mitting, his efforts will be in vain. Medicine will 
prove but of little efficacy, if the animal powers are 
not fupported by proper nourifhment : the attend- 
ants muft, therefore, conftantly fupply the patient 
with fago, falop, panada, &c. to which muft be 
added, fuch wine as may be moft agreeable to . his 
palate. Red port made into negus, may be alfo 
given freely : ripe acid fruits, and fermenting 
liquors, as bottled cyder, perry, champaigne, &c. 
mould conftitute part of the patient's drink. . But 
previoufly to the fwallowing of nutriment, anti- 
feptic gargles and injections mould be very fedu- 
loufly employed, for clearing away the fharp and 
and feptic humour from the mouth and throat, to 
prevent, as much as poffible, its being fwallowed ; 
fince from the efcape of it into the alimentary canal, 
a moft troublefome and dangerous diarrhaea fre- 
quently occurs towards the clofe of the complaint. 
It is impoflible to be more explicit here refpedting 

diet, 



I48 MEDICAL ADMONITIONS, 

diet, as this muft fo much depend on the ftate of 
the patient, the period of the difeafe, and the con- 
dition of the ftomach, as to require it to be par- 
ticularly pointed out, after a careful confideration 
of thefe circumftances. 

The patient mould be fo placed in his bed, that 
the difeharge may run freely out at the corners of 
the mouth ; great attention muft alfo be paid to 
the cleanlinefs of his clothing, and the ventilation 
of his apartment. 

When it falls to the lot of a tender parent, to 
yiew the progrefs of this difeafe in a darling child, 
the fcene is truly diftrefling. For too often here, 
from an ill judged tendernefs, the parent will not 
fufFer the ravages of this horrid malady to be 
checked, from a repugnance to increafe his tem- 
porary fufferings. It is true, that almoft all the 
means that are indicated, in fome meafure do this ; 
for in fuch a ftate of the fauces, to fwallow the 
mod bland fluid fubftance muft give pain, and this 
muft neceffarily be excited in a greater degree, by 
forcing the patient to fubmit to warn the throat 
with antifeptic gargles, and to fwallow {harp acid 
liquors, and unpalatable medicines. But for the 
fake of preventing this mifapplication of tender- 
nefs, it fhould be confidered, that although for the 
time the pain is augmented, yet in confequence of 

th£ 



MEDICAL ADMONITIONS, $49 

the fymptoms being moderated by this mode o£ 
treatment, the quantity of pain muft on the whole 
be thereby much leflened ; befides the grand and 
important end of faving life being alfo probably 
anfwered. And furely, although the principle is. 
fo often acted on, no parent will avow a right of 
rifquing the life of a child, for the indulgence of 
his own lympathetic feelings* The reflection, that 
he has, by his interpolition, leffened his fufferings, 
but, at the fame time, haftened, or even occalioned 
his death, is widely different from the rapturous 
ideas of him, who, with an almoft rent heart, has 
allowed or even prompted, that to be done, which, 
painful at the moment to fuffer, did, in the end, 
alleviate the fufferings of his child, and reftore him 
to his cardies. 

In no difeafe more than this, is there required fo 
implicit a confidence in the phyfician, and, of courfe, 
fo exact a compliance with all his directions ; lince 
the moft trifling omiflion may occafion the death 
of the patient, , 



THE CROUP, OR QUINSY OF THE TRA- 
CHEA OR WINDPIPE. 

The exquifite degree of danger, which always 
accompanies this difeafe, the rapidity with which 
its fymptoms proceed, and the probability of its 

efcaping 



150 MEDICAL ADMONITIONS. 

efcaping a fufficiently early detection, will induce 
me to be rather diffufe in its defcription j hoping, 
that parents may thereby be enabled to difcover it, 
immediately on its appearance, and be induced to 
apply for medical aid in the firft moments of the 
difeafe. 

The unfortunate fubje&s of this malady are, 
almoft always, children under twelve years of age. 
The attack is, in general, preceded by fymptoms 
refembling thofe of a common cold j "but fome- 
times it comes on fuddenly, beginning with a flight 
forenefs of the throat, a hoarfenefs, or rather a 
peculiar ringing found in fpeaking, a fhrill barking 
cough, and a remarkable wheezing which accom- 
panies the refpiration. Both infpiration and expi- 
ration are performed in a much longer time than 
is natural, and evidently with difficulty ; and when 
the child coughs, which is rather frequent, and in 
redoubled fits, the face is much fwelled and nufhed, 
and the child is violently agitated. At the begin- 
ning, the cough produces little or no expe&oration. 
Upon prefling with the finger on the neck, imme- 
diately oppofite to the windpipe, the uneafmefs of 
the child is evidently increafed. There is, in gen- 
eral, little or no difficulty in fwallowing, nor any 
appearance of inflammation upon infpecling the 
fauces. As the difeafe increafes, the pulfe quickens, 
the heat augments, and an exccflive reftleflhefs takes 

place. 



MEDICAL ADMONITIONS. I£I 

place. This reftlefmefs foon increafes to fuch a de- 
gree, that the patient cannot be retained many mo- 
ments in the fame pofture ; the breathing becomes 
more and more difficult and laborious, and the pe- 
culiar wheezing founds which accompanies it fo in* 
creafes, as to be heard at a confiderable diftance. 
The cough alfo increafes in frequency, and, at the 
fame time, in the violence of its efforts, by which 
are brought away fmall quantities of a matter of a 
purulent appearance, and portions Gf a white tubular 
membranous fubftance. The fymptoms continue 
to increafe in violence, until a fpafm of the mufcles 
of the parts taking place, the patient is fuffocated ; 
the djfeafe often completing its courfe in the fpace 
of three or four days and nights. 

By the diffe&ions of thofe who have been de- 
ftroyed by this difeafe, the caufe of thefe various 
fymptoms is rendered very evident. A preterna- 
tural membrane having been found to line the 
whole inner furface. of the trachea, in fome parts 
adhering to it, and in others a little feparated from 
it ; a matter refembling pus appearing to be inter- 
pofed between the trachea and its morbid coverings 
and fometimes the preternatural membrane and 
the above-mentioned pus like matter is found, not 
only to cover the whole inner furface of the tracheay 
but even to reach into the bronchia, 

On 



tj2 MEDICAL ADMONITIONS. 

On the firft appearance of thofe fymptoms whicli 
tnark the exiftence of this difeafe, immediate appli- 
cation fhould be made for medical affiftance, and 
not a moment fhould be wafted* before the propo- 
fed remedies mould be tried. 

But fince it may fometimes happen, that medical 
advice cannot be immediately procured, by an at- 
tention to the following directions the difeafe may 
be checked in its progrefs, if not entirely removed. 
As foon as the difeafe is difcovered, from three to 
fix leeches, according to the age and ftrength of 
the patient, may be applied to the upper and fore 
part of the neck, and the bleeding promoted by the 
application of clothes wrung out of warm water. 
As foon as the leeches fall off and before the bleed- 
ing has ceafed, the patient may be laid between the 
blankets, and fupplied with warm barley water to 
excite fweating, the front of the neck being covered 
with a blifter. In performing thefe various opera- 
tions, fo much time muft elapfe, as to afford a fuf- 
ficient opportunity of obtaining proper medical 
attendance j and as the fubfequent treatment 
muft depend on the effecl:s produced, by the means 
which have been already employed, it would not 
be proper here to proceed in an account of the 
mode of treatment, which can only be dire&ed by 
the attending phyfician. 



MEDICAL ADMONITIONS. - IJ3 

A deep, hard-founding cough, almoft exactly 
refembling the cough in the croup, fometimes 
occurs in children, but without any of the other 
chara&eriftic fymptoms of this difeafe. In thefe 
cafes, the ordinary demulcent remedies, in general, 
foon fucceed in removing the cough. Dr. Ferriar^ 
of Manchefter, obferves, that, *the diftin&ions 
between this fpurious croup and the genuine 
difeafe are only to be learned, from much atten- 
tion to the different cafes of the difeafe ; for the 
found of the cough is fo fimilar in both, as to 
infpire even the moft experienced with fome de- 
gree of doubt. I have fat by the child's bed-fide: 
repeatedly, watching for the moment Of danger, 
while the cough was increafing in violence ; and 
have been only undeceived, by finding that no 
tremor or palpitation came on towards midnight, 
that the reftlefsnefs abated, and that fleep feemed 
to become more compofed." The fpurious difeafe* 
feems to be unaccompanied with inflammation 5 
but the genuine croup has been clearly proved to 
be an highly inflammatory difeafe, by repeated dif- 
fe&ions. And here trufting that you will excufe 
the digreihon, I will offer a few words, with the 
hope of leffening the too general repugnance of 
relatives to the examination of thofe, who have 
fallen victims to any ambiguous difeafe. 

Some of the moll learned arid pblifhed nations 
U have 



1 54 MEDICAL ADMONITIONS. 

have coniidered the procefs of opening the body* 
and embalming it, as a mark of refpecl, without 
which the body ought never to be configned to the 
tomb. Even at the prefent moment, in this king- 
dom, and over a confiderable part of Europe, this 
procefs is deemed fo honorable, as to be confined 
by cuftom to thofe only of the moft elevated rank. 
Thus, whilft. fufFering humanity in vain petitions 
for fuch an infpection, as may, perhaps, afford the 
information which may fave the lives and leffen 
the torments of numbers, pride obtains, with the 
utmoft alacrity, the complete difemboweling of 
one, who, whilft living, received almoft the adora- 
tion of a divinity. But, perhaps, the deeply 
rooted prejudices of fentiment are not likely to 
be overcome, merely by contrafting them with the 
filly adoptions of vanity and pride. 

At the very point of time in which a beloved 
object is matched away, it mull be expected, that 
the mind will indignantly revolt at any meafure 
which does not accord with thofe nicely attuned 
feelings, which the revered memory of departed 
excellence, and the violent grief at the cruel depri- 
vation, neceffarily produce. The mind, diftracl:- 
edly alive, is impreffed with the utmoft horror at 
the idea of any mutilation or injury to that form, 
which, by the unalterable laws of nature, muft, in 
i few hours, entirely difTolve away. Imagination 

paints 



MEDICAL ADMONITIONS. 1 55 

paints the fpirit of the departed as difplcafed by 
this affumed injurious violation of its former resi- 
dence : but imagination mould rather depid a 
countenance, beaming with kind, commiferation 
and benignity, and expreuive of the purefl delight 
at perceiving, that its perilhing exuvi<s may be ren- 
dered ufeful, in mitigating the fufferings of furviv* 
ing relatives. The only hopes which can be enter- 
tained of overcoming this repugnance to anatomi- 
cal examination, founded, as it mufl be acknow* 
ledged to be, on the finefl feelings of human nature, 
is, by an appeal to kindred feelings, to that tender 
fympathy which difpofes its polfeffor to feel the 
fufferings of others as his own ; and to that benev- 
olence, which induces him to make the moll im- 
portant facrifices, with the hope, that pain and 
mifery may be averted from others. 

Let it then be recollected, that the knowledge of 
thofe difeafes, which it is in the power of art to 
relieve, or remove, has chiefly been obtained by 
anatomical enquiries ; and that, in a perfeverance 
in thefe, mull be placed our hopes of obtaining a 
more accurate knowledge of fuch difeafes, as have 
hitherto refilled the powers of medicine. He who 
now, from an improper indulgence of his tender- 
nefs, refufes to permit the required examination, 
may experience the mortification of fuffering him- 
felf, or of witneffing the fufferings of another part 

of 



J 56 MEDICAL ADMONITIONS. 

of the family, from a limilar malady ; when, per« 
haps, by the propofed enquiry, that intelligence 
might have been gained, by which the difeafe 
might now have been removed. The acknow- 
ledged hereditary difpofition to fimilar difeafes, in 
children of the fame family, is a circumftance 
which cannot be reflected on, without confirming 
the propriety of what has been juft remarked. 

The difeafe, of which we are now again to fpeak, 
affords a ftrong inftance of the advantages which 
proceed from anatomical inveftigations, in ambi- 
guous cafes. The real nature of this difeafe, and, 
of courfe, the proper means of treating it, have 
only been known of late years ; the difcovery 
being the confequence of obferving the appearan- 
ces of the parts after death. 

For the purpofe of preventing this dreadful 
difeafe, befides attending to the general rules, 
already given for the prevention of inflammation, 
great care mould be taken, that children mould 
not be expofed to extremely cold air, for any con- 
fiderable time. With the hope of rendering chil- 
dren hardy and robuft, they are fent out, in the 
arms of their nurfes, during the molt fevere cold 
weather, for hours together, and, too commonly, 
not fufEciently clad. The poor infant, at the firft 
expofure, declares, by its cries, the uneafmefs it fuf- 
fers ; but after a little time, overcome by the 

feverity 



MEDICAL ADMONITIONS. 



•V 



feverity of the cold, it falls faft afleep.* In this 

ftate 

* From the found fleep in which children are feen who are 
thus expofed, it may be imagined, that the cold is no more 
than they can bear, without a chance of injury. But that this 
fleep itfelf may be the confequence of the exceffive cold, appears 
to be very probable* upon recollecting the effects of cold, as 
defcribed in the firft voyage of Capt. Cooke for making difcov- 
eries in the fouthern hemifphere. During their ftay at Terra 
del Fuego, Mr. Banks, and Dr. Solander, with a party compofed ■ 
of draughtfmen, &c. had made an excurfion into the interior 
of the country. It being eight in the evening, the blafts of 
wind very piercing, and the fnow falling thick, they were paf- 
fing through a fwamp, towards a wood, in the covert of which 
they propofed building a hut, and kindling a fire* to defend 
themfelves from the feverity of the weather. Dr. Solander 
having often paffed over mountains in cold countries, was fen- 
fible, that extreme cold, when joined with fatigue, occafions a 
drowfinels that is not eafily refifted ; he therefore intreated his 
friends to keep in motion, however difagreeable it might be to 
them. His words were— ^Whoever fits down, will fleep ; and 
whoever fleeps, will wake no more. — -Every one feemed ac- 
cordingly armed with refolurion ; but, on a fudden, the cold 
became (o intenfe, as to threaten the moft dreadful effeds. It 
was now very remarkable, that thfe doctor hirafelf, who had 
fo forcibly admoniftjed and alarmed his party, was the firft that 
infilled to be fuffered to repofe. In fpite of the moft earneft 
intreaties of his friends, he lay down amidft the fnow ; and it 
was with difficulty they kept him awake. One of the black 
fervants alfo became weak and faint, and was on the point of 
following this bad example. A party was therefore detached, 
%o make a fire at the firft commodious fpot they could find. 
Mr. Banks and four more remained with the Doctor and Rich- 
mond 



I58 MEDICAL ADMONITIONS. 

ftate, with their extremities fo chilled as to be of a 
dark crimfon hue, may children be feen every win- 
ter, in all the public walks round the metropolis. 
On their return home, the chilled appearance of 
their arms and legs excites the attention and the 
exertions of their parents or nurfes, who imme- 
diately laying them on their knees, chafe them 
before the fire, until the parts have acquired a con- 
fiderable degree of warmth. The danger of this 
ludden tranfition from one extreme of temperature 
to another, has been already remarked : I fhall 
only, therefore, obferve here, that by fuch improper 
management, this difeafe, or inflammation of the 
lungs, is very likely to be induced. ^^ 

mond the black, who with the utmoft difficulty were perfuaded 
to come on ; and when they had traverfed the greateft part of 
the fwamp, they exprefTed their inability of going any farther. 
When the black was told, that if he remained there he would 
foon be frozen to death, his reply was, that he was fo much 
exhaufted with fatigue, that death would be a relief to him. 
Dr. Solander faid, he was not unwilling to go, but that he 
muft firft take fome fleep ; ftill perfifting in acting contrary to 
the opinion which he had himfelf delivered to the company. 
Thus refolved, they both fat down, fupported by fome bufhes, 
and in a fhort time fell afleep. Intelligence now came from 
the advanced party, that a fire was kindled about a quarter of 
a mile farther on the way. Mr. Banks then awakened the 
Doctor, who had already almofl loft the ufe of his limbs, though 
it was but a few minutes fince he fat down ; neverthelefs he 
confented to go on, but every meafure taken to relieve the 
black proved ineffectual. 



MEDICAL ADMONITIONS. 159 

This expofure of infants to extreme cold, is not 
defenfible on any hypothelis ; and fo far from 
being calculated to render them hardy, it is more 
probable, that, by thus occafioning difeafes, it will 
render them tender and weakly. The parents of 
children who refide in cities, ftruck with the ap- 
pearances of ftrong health, which fometimes mark 
the countenances of little cottagers, who, almoft 
unprotected by clothing, brave the coideft and 
raoft inclement feafons, flatter themfelves, that, by 
iimilar expofure, they ihali obtain for their children 
an exemption from difeafe. But this expectation 
is the refult of a very erroneous calculation. The 
vaft number of little victims, who fall by various 
difeafes, the conferences of this expofure to every 
inclemency of feafon, is not reckoned ; and the 
poor invalids, whom difeafe or weaknefs, produced 
by the fame caufe, keeps within doors, are un- 
known to the paffenger, who makes his eftimate 
only from thofe few who have hitherto efcaped, 
hotwithftanding the miferies to which they have 
been expofed. That thofe who thus efcape, may 
originally have been of the moil ftrong conftitu- 
tions, is reafonable to fuppofe : they are therefore, 
of courfe, children of fuch an appearance, as will 
be moft likely to excite a favourable opinion of 
their mode of being reared. 

If this flatement were not true, and, on the coft- 

trarv. 



\6o MEDICAL ADMONITIONS. 

trary,, if the children of nifties bore this expofure 
to extreme cold without injury, ftill this would not 
authorife that expofure which I have here made a 
fubjecr of reprehenfion. To prove this, let it be 
confidered, that the expofure of the children of the 
poor is regular and uniform, their lodging is gene- 
rally fo wretched, that the difference of tempera- 
ture between the external air and that of their 
hovel is feldom very confiderable ; and that they 
are, therefore, but little expofed to fudden and con- 
fiderable changes of temperature. But it is very 
different with thofe children, whofe caufe I am 
wifhing to plead, who dwell chiefly in apartments, 
from which the cold air is excluded as much as 
poffible, and which are alfo heated by large fires. 
Thefe children mull be generally in fuch a ftate* 
that the fudden expofure to cold may be very likely 
to occafion the moft ferious confequences. 

Another circumfiance which may probably occa- 
fion this difeafe, and which, therefore, ought to be 
carefully prevented, is exertion of the voice by hol- 
lowing, fcreaming, &c. In two of the cafes I have 
witneffed, the difeafe feemed to have been thus 
produced. In the one cafe, a child, three years 
old, whofe legs had been fcaHed by boiling water, 
had fcreamed inceffantly, and with the utmoft vio- 
lence, for five or fix hours : and was feized, the fol- 
lowing night, with this difeafe, of which if: died. In 

the 



MEDICAL ADMONITIONS. l6l 

the other cafe, a boy, about feven years of age, had 
been celebrating in a proceflion, the day of quit- 
ting fchool for vacation, and had, according to a 
very filly cuftom, been engaged with his fchool- 
fellows in huzzaing, almoft during the whole time, 
with his utmoft exertion. He was attacked the 
fame evening with this difeafe, and was, the next 
day, evidently in a confiderable degree of danger j 
but happily recovered, in confequence of being 
freely blooded, bliftered, &c. 



QUINSY OF THE PAROTID GLAND, 

OR THE MUMPS. 

This difeafe is diftinguifhed by a confiderable 
fwellinsj, which arifes very rapidly, in general, on 
each fide of the neck, becoming large, and fome- 
times painful : the fwelling increafes for three or 
four days, when it begins to decline, and in a few 
days entirely difappears. It frequently happens, 
that, as the fwelling of the neck fubfides, the tefti- 
cles of the male, and the breafts of the female, are 
affe&ed with hard and painful tumours. A flight 
fever is obfervable through the whole progrefs of 
this difeafe, which goes off, in general, as the fwel- 
ling declines. 

This difeafe, in common, requires but little med- 

ical-affiftance ; it being generally fufficient, that the 

W patient 



1 62 MEDICAL ADMONITIONS. 

patient keeps himfelf in the houfe, with a moder- 
ately warm covering round the neck ; that he 
drinks freely of warm diluting liquors ; and pre- 
ferves the bowels rather in a relaxed ftate, by the 
occafional ufe of gentle laxatives. ' 

Dr. Cullen obferves, that "fometimes, when the 
fwelling of the tefticles does not fucceed to that of 
the fauces, or when the one or the other has been 
fuddenly repreffed, the pyrexia, or fever, becomes 
more confiderable, is often attended with delirium, 
and has fometimes proved fatal." Inftances of this 
kind are, indeed, not very frequent ; but this obfer- 
vation ought to excite a confiderable degree of vigi- 
lance, as the increafe of fever may demand the moft 
vigorous exertions. 

This circumftance will alfo ferve to evince the 
danger of confiding in domeftic practice, even in a 
diieafe apparently trifling ; fince, in this cafe, the 
danger may become very confiderable, before it is 
detected. 



INFLAMMATION OF THE EAR. 

There frequently occurs, in the progrefs of the 
foregoing difeafe, a painful affection of the ear, 
which caufes much trouble to the patient. This is 
generally occafioned by inflammation in the cavity 

of 



MEDICAL ADMONITIONS. 1 63 

of the ear, and may be produced independent of 
this difeafe, by expofure to cold, &c. In flight 
cafes, this affection may be removed by a little 
warm oil of almonds dropped into the ear, with 
the application of a warm bread and milk poultice, 
or a bag of camomile flowers, which have been 
infufed in boiling water, and which fhould be ap- 
plied as warm as poffible. 

But, mould it not foon give way to thefe means, 
it will be neceffary to obtain proper chirurgical 
advice, left fuppuration mould take place, and be 
fucceeded by a total lofs of hearing in the ear 
which is affected. 



TOOTH-ACH. 



The term tooth-ach, is, indeed, only expreilive of 
pain of the tooth ; which may be produced by 
almoft all the various difeafes to which the teeth 
are fubject. In other words it is only the name of 
a fymptom of fome difeafe with which the tooth is 
affected. The common acceptation of the term, as 
the name of a difeafe itfelf, is productive of very 
erroneous practice, among the profeffors of domes- 
tic medicine j a confiderable number of contrary 
means fwelling their catalogue of fpecifics, for the 
cure of this fymptom 5 whiift the actual difeafe, 

and 



164 MEDICAL ADMONITIONS. 

and the caufe on which this fymptom depends, are 
unheeded. 

Tooth-ach is, generally, a fymptom of a Caries 
of the tooth j or of fuch a difeafe of the tooth, as 
will, if not cured, terminate in Caries. It fome- 
times occurs in confequence of the teeth being 
affected by fcurvy, and fometimes it follows the 
ufe of mercury. It may alfo be occaficned by acrid 
matters applied to a tooth already difeafed, or it 
may proceed from a rheumatic affection. The dif- 
eafe from which it proceeds may exift in the body 
of the tooth, or in that part, termed its roots ; the 
feat of the difeafe, which may be defcribed as tooth- 
ach, may be, even in the antrum highmori, a cavity 
in the bone of the upper jaw. 

The applications, which in general, are had re- 
courfe to on thefe various occafions, are ardent 
fpirits, effential oils, and various other medicines 
poffefling confiderable cauftic power. Sometimes, 
with the expectation of deftroying the nerve, aqua 
fortis is dropped in the tooth. The mifchiefs which 
refult from fuch applications to parts which are in 
the higheft ftate of irritability and inflammation, 
are often of a very ferious nature. 

From the enumeration I juft now made of a few 
of the many caufes, from which this very painful 
difeafe may proceed, it muft appear very obvious, 

* that 



MEDICAL ADMONITIONS. 1 65 

that the general mode of proceeding of thofe who 
fuffer from it, is in the higheft degree improper. 
When the pain becomes difficult to bear, recourfe 
is had to a variety of applications, external and in- 
ternal ; which, being felected without judgement, 
feldom produce any beneficial effects ; but moft 
commonly, in confequence of. their being highly 
ftimulant, or even efcharotic, the fufferings of the 
patient are increafed, the difeafe augmented, and 
the tooth often irreparably injured. Should thefe 
means fail, which, as may be fuppofed, is generally 
the cafe, application is made to fome neighbouring 
tooth-drawer, and the marked, though perhaps 
found, tooth, is removed without any further en- 
quiry. 

The general ftate of the fyftem, the predifpofing, 
as well as the exciting caufe, and the real nature 
of the difeafe, ihould be carefully enquired into. 
If this be done by an intelligent profeffional char- 
acter, the patient may not only obtain prefent 
relief j but, by the difeafe being fpeedily removed, 
future pain and decay of the tooth may be alfo 
prevented. 

To give advice fufficient to enable domeftic prac- 
titioners to treat, with propriety, all the different 
cafes of this difeafe, is impoflible. To provide them 
with fuch a mode of treating tooth-ach, at its com- 
mencements 



1 65 MEDICAL ADMONITIONS. 

mencement, as will not only be generally fafe, but 
as will alfo be likely to render farther affiftance un- 
neceffary, is all that can be here attempted. 

Should a tooth, which, on examination, appears 
to be perfectly found, be affected with exceffive 
pain ; it will be proper, as foon as poffible, to put 
the feet and legs into warm water, in which they 
may remain about a quarter of an hour. After 
this, the patient mould go into bed, fecuring on 
the pained fide of the face, a piece of doubled flan- 
nel, wetted with any fpirits, made warm, by being 
held in a faucer over ihe flame of a candle : he 
mould alfo drink freely of warm barley-water, or 
of any other diluting drink ; and endeavour to ex- 
cite perfpiration, as fpeedily as poffible, by breathing 
under the bed-clothes, &c. Should the pain ftill 
continue, leeches may be applied externally, near 
the angle of the jaw, and, a blifter alfo may be 
applied behind the ear. 

If the tooth is conflderably decayed, a doflil of 
lint dipped in the tincture of opium, or a fmall pill 
of the opium pill of the fhops, may be introduced 
into the cavity, and occafionally renewed. If this 
fimple, but frequently efficacious, plan mould fail, 
application muft be made to fome furgeon, or fkil- 
ful dentifl. 

TEETHING 



MEDICAL ADMONITIONS. 1 6/ 

TEETHING. 

It was originally my intention to have allotted 
one part of this work, entirely to the difeafes of 
children, and to obfervations refpe&ing their cloth- 
ing, diet, &c. But, on confidering how fully and 
ably their difeafes have been treated by Dr. Under- 
wood, and that Dr. Buchan has announced his 
intention of publifhing an effay, On the Duties and 
Office of a Mother •, (a work which, from the atten- 
tion the Dodor has paid to this fubjecl:, cannot 
fail to be in the higheft degree ufeful,) I refolved 
only to interfperfe fuch detached obfervations, on 
the difeafes of children, as appeared likely to be 
moft particularly interefting. The mifchiefs which 
arife from dentition being., moft probably the con* 
fequence of the inflammation of the membrane 
invefting the teeth, this appeared to be the moft 
appropriate place for the introduction of thefe 
remarks on teething. 

The complaints occafioned by dentition are nu- 
merous, and frequently highly dangerous ; feverifh 
complaints^ and inflammation of the lungs, and of 
other important parts, frequently arifing from this 
caufe. The two front teeth, in the lower jaw, are 
thofe which ufually firft appear -, and this, feldom 
before the fourth, or after the tenth, month. The 
two oppofite ones in the upper jaw next appear ; 
and the remainder in irregular fucceflion. 

The 



1 68 MEDICAL ADMONITIONS. 

The fymptoms of dentition are, fwelling, rednefs, 
and fpreading of the gums ; flufhings of the cheeks, 
and flavering from the mouth. Sometimes erup- 
tions appear on various parts of the fkin, and gene- 
rally the bowels are difordered, and the ftools in- 
creafed in number. The child is employed, almoft 
conftantly, in endeavouring to mitigate his pain, 
by biting any fubftance he can thruft in his mouth. 
The urine fuffers various changes, fometimes com- 
ing away quite pale, and at other times high col- 
oured 5 and depofiting, fometimes a thick white, 
and at other times a reddifh, fediment. 

The fymptoms already defcribed, are thofe which 
occur in cafes of eafy dentition ; but with difficult 
and painful dentition, fymptoms arife which are 
not only dangerous, but are often fuch as the expe- 
rienced only can trace to their real caufe. Such 
are, various fpafmodic affections, violent convul- 
sive fits, cough, fhortnefs of breathing, and acute 
fever. 

When the firft defcribed fet of fymptoms begin 
to appear, care mould be taken, that the child's 
bowels are kept rather open, and that his food be 
rather lightened, both in quantity and quality. 
Expofure to the air mould be continued, nearly as 
much as in perfect health ; but the fkin mould be 
guarded from the effects of much cold. But mould 

any 



MEDICAL ADMONITIONS* l6g 

any of the latter-mentioned fymptoms appear, a 
free incifion mould be made down to the tooth* 
which is painfully wounding and diftending, not 
merely the gum, but the irritable membrane which 
immediately invefts the teeth until their protru- 
liom 

Far is it from my expectation, that I mould 
be able to add a fingle argument to thofe which 
have been already employed by others, for the 
purpofe of procuring a more ready fubmiflion to 
this fafe, ufeful, and often abfolutely heceffary, 
operation. Induced, however, by the hope, that 
I may chance to place the circiimftances in a differ- 
ent, and perhaps ftronger light, I will juft call your 
attention to the ftate of the parts, and to the actual 
effects of the operation. I Will then leave it to yoii 
to determine, not merely whether, having it in our 
power to remove them, the actual torments of the 
child ought to be permitted, becaufe the parent 
mall not be teized with fentimental and fympa- 
thetic feelings for the fancied fufferings of his child'', 
under an operation abfolutely not fo painful as the 
fcratch of a pin. No ! the queftion on which you 
fhall be called to decide, is one of a much more 
ferious nature,* 

When the teeth haVe acquired that lize and form 

which nature intended, they are pufhed forward 5 

diftending the membrane which invefts them, which, 

X with 



\ 



170 MEDICAL ADMONITIONS. 

with the gums, become inflamed and very fenfible. 
In cafes of eafy dentition, thefe however foon yield* 
and the teeth are protruded without much diffi- 
culty. But in cafes where the cutting of the teeth 
is much protracted, the inflammation and the fen- 
fibility of the gums, and of the membrane invert- 
ing the tooth, are very confiderable, and, in this 
ftate of extreme tendernefs, become tightly ftretched 
over the fharp points of the fubjacent teeth, necef- 
farily producing exquifite pain, which is fufficiently 
manifefted by the frequent fhrieks, and almoft con- 
flant cries of the poor child. If thefe diftrefsful 
appeals for help fail of exciting the parents to the 
adoption of efficacious means of relief, fever, con- 
vulflons, and death, foon enfue. But if, attending 
to the plain language of nature, they permit the 
painfully ftretched parts to be entirely divided, the 
inflamed gums and membrane immediately recede, 
the inflammation goes off, the pain ceafes, and the 
tooth fometimes immediately protrudes. 

Now fay, in thofe cafes where this operation is 
fo directly demanded, as the price of the life of a 
child, can a parent withhold it without fubjecting 

himfelf to the charge of ? But much more 

guilty are thofe, who actually entice the unhappy 
mother to devote her child to the fufferings I have 
juft defcribed, and even to death itfelf, by occa- 
fioning her reliance on means totally incapable of 

yielding. 



MEDICAL ADMONITIONS, 17I 

yielding the fmallefl relief. Such are the various 
forms of neck-laces, by which thefe perfons pre- 
tenoVthat the fpeedy and eafy cutting of the teeth 
will certainly be obtained, 

So little pain is occafioned by lancing the gum 
over the diftending tooth, and inch immediate re-? 
lief is often derived from it, that it frequently hap- 
pens, that a child, who, the moment before, ap- 
peared to be in great agony, will bellow a grateful 
fmile, the inflant the incifion is made ; and if, as 
fometimes happens, the gum grows again over the 
tooth, will not only cheerfully fubmit to the opei>. 
ation, but even appear to iolicit it. 

I have been more earneft in urging parents to 
permit this little operation, fearing that the affer- 
tion of Dr. Buchan, that " With regard to cutting 
" the gums, we have feldom known it of any great 
w benefit," may have, not a little, kept up that re- 
pugnance in parents to the operation, with which 
medical men fo often have to combat. Againfl 
this affertion I am unwilling to oppofe my own 
opinion alone, and mail therefore offer to your 
notice the declarations of one, whofe authority, in 
this inflance, is not likely to be difputed. " I am 
convinced from experience, that this little opera- 
, tion is often inexpreflibly ufeful, and appears to 
have faved many lives, after the moil dangerous 
fymptoms had taken place, and every other means 

of 



\ 



172 MEDICAL ADMONITIONS. 

of cure had been made ufe of. 1 have feen the 

like good effects from it, wli£n children have been 
cutting a number of teeth in fucceflion, and have 
bred them all with convulfions ; nothing having 
relieved or prevented thefe terrible fymptoms, but 
lancing the gums, which has removed them every 
time it has been done, one or more teeth appearing 
a day or two after each operation.*'* Similar re- 
marks have been made by Mr. John Hunter. 

Dr. Buchan farther fays, "In obftinate cafes how- 
" ever, it ought to be tried. It may be performed 
" by the finger-nail, tine edge of a fixpenny piece 
" that is worn thin, or any fharp body which can 
" be with fafety introduced into the mouth ; but 
? 6 the lancet, in a fkillful hand, is certainly the mofl 
c< proper." 

The conceffion that hi obftinate cafes it ought to 
be tried, will, I fufpeft, have but little power in 
overcoming the averfion to the operation ; when 
it is confidered, that the immediately preceding 
fentence contains the aflertion, that it has feldom 
been known to be of any great benefit. 

The mode in which Dr. Buchan fays it may be 
performed is in every refpecl objectionable ; but 

particularly 

* Treatife on the Difeafes of Children, by Dr. Underwood, 
vol. i. p. 328. 



MEDICAL ADMONITIONS. 173 

particularly on account of its inefficacy, and of its 
inducing parents to reft fatisfied with the operation 
fo imperfectly performed, as not to afford the child 
a probability of relief. Dr. Underwood obferves, 
& When it is found neceffary to lance the gums, it 
mould always be done effectually, with a proper 
gum lancet, and not with a needle, a thin fix pence, 
or fuch like inftrument, which will not fufficiently 
divide the gum, nor the ftrong membrane that 
covers the teeth."* 

Befides lancing the gums, other remedies will be 
required j but as thefe mull be adapted to the dif- 
ferent fymptoms which arife, it is hardly poflible 
to point them out here. 

Sorenefs and flight ulcerations behind the ears, 
frequently occur to children, during the time of 
dentition ; and will even continue, for fome time, 
not only without injury, but even with advantage 
to the child. In fuch cafes, little more is required, 
than to keep the bowels in a regular ftate, to keep 
the fores clean, and covered with a fold of lint, 
which has been made to imbibe a very fmall quan- 
tity of oil of almonds. Sometimes thefe ulcera- 
tions will be covered with gangrenous floughs, and 
will fpread into deep fores, extending to the fides 
of the neck. Here, it will be fufficient to fay, that 

the 

* Treatifc on the Difeafes c£ Children, vol. i. p.^27. 



174 MEDICAL ADMONITIONS. 

the difagreeable fears, which are fometimes left by 
tliefe fores, render the complaint fufficiently ferious, 
to require the greatefl judgment in prefcribing the 
appropriate external, as well as internal remedies ; 
and therefore ought never to be trufted to the en- 
tire management of a nurfe. 



PNEUMONIC INFLAMMATION, 

OR 

INFLAMMATION OF THE LUNGS. 

Inflammation of the membrane which is fpread 
over the cavity of the cheft, and on the vifcera it 
contains, is difcovered by pain in the affected part, 
difficulty of breathing, cough and fever. 

Whether the inflammation poffeffes any of the 
vifcera themfelves, or the membrane which inverts 
them and the whole furface of the cavity, is very 
difficult to be afcertained. This, however, is not 
of much coniequence ; fince the mode of treatment, 
at lead, in the commencement of the attack, would 
in each of thefe cafes, be very little different from 
each other. 

In general, the difeafe commences with fhivering, 
to which confiderable heat fucceeds : the pain com- 
ing on and increafing with the heat. In fome ca- 

fes a 



MEDICAL ADMONITIONS. 1 75 

fes, the fever will exift for fome hours, before the 
pain and difficulty of breathing become very trou- 
blefome ; and fometimes the pain and difficulty of 
breathing will be very confiderable, although little 
or no alteration in the Hate of the pulfe, or the 
temperature of the body, takes place. 

From this circumftance arifes a very confiderable 
degree of ambiguity, which will demand, even 
from thofe who are accuftomed to watch the rife 
and progrefs of difeafe, the moft careful inveftiga- 
tion j and muff: undoubtedly render it utterly un- 
fafe to truft to the judgement of the unexperienced. 

It is very evident, that the feat of the inflamma- 
tion, and confequently of the pain, may vary in 
different cafes ; fometimes occupying the middle 
part of the cheft, beneath the breaft bone, extend- 
to the back between the moulders. In thefe cafes 2 
the feat of the difeafe is, moft probably, in the 
mediaftinum, which makes the divilion between 
the two fides of the cheft. 

Sometimes the pain extends from the pit of the 
ftomach, all round the body. ' The diaphragm 3 in 
this cafe, may be fappofed to be inflamed. 

When with fever, there exifts a pain in the region 
of the heart, great anxiety, difficulty of breathings 

cough. 



I76 MEDICAL ADMONITIONS. 

cough, irregular pulfe, palpitation, and fainting, 
the inflammation may be fuppofed to poffefs the 
heart itfelf, or furrounding membrane. 

Pleurify, as it is generally, and not improperly, 
termed, is the moft common form, in which this 
difeafe makes its attack. • An exceffively fharp and 
pungent pain, in this cafe, feizes the fide, between 
the fixth ancbfeventh rib, and is, in moft cafes, ei- 
ther accompanied, or fucceeded, by a confiderable 
degree of fever, and a full, hard, and quick pulfe ; 
the urine being alfo, at the fame time, exceedingly 
high colored. The pain, commonly, is not confin- 
ed to one fpot, but darts from the fide towards the 
breaft bone, or back, and fometimes extends itfelf, 
with a particularly diftrefling aching pain, towards 
the collar bone, 

Thofe who are of a robuft habit, and of a florid 
complexion, are moft difpofed to attacks of this 
difeafe. Males, from their greater ftrength of fibre, 
and from their being more expofed to the exciting 
caufes, are more fubject to this malady than fe- 
males. Young perfons are more liable to it than 
the aged : and thofe who indulge much in eating, 
particularly of animal food ; as well as thofe who 
have fuffered a fuppreflion of fome habitual dif- 
charge, by having a fulnefs of blood produced, 
frequently fuffer from it. 

The 



Medical admonitions. ijf 

The exciting caufes of this difeafe may be, full 
meals of vifcid and ftimulating fubftances, fuch as 
fmoked and faked meats, joined with fpiceries 5 
drinking freely of fermented or fpirituous liquors, 
violent and long continued exercife, expofure to 
damp and cold air, when the body has been pre- 
vioufly heated, and the fudden tranfition from ex- 
treme cold to heat. 

The terminations of this difeafe, like other in- 
flammations, may be, by refolution, fuppuration* 
or gangrene ; befides which, it has a termination 
peculiar to inflammation of the lungs, which is, an 
effufion of blood into their cellular fubftance, which 
interrupting the circulation of the blood and ref- 
piration, foon produces fuffbcation ; an exudation 
on the furfaee of the pleura, has been found, by 
defection, frequently to have taken placgi 

For the cure of this difeafe, large evacuations are 
required : that which is particularly beneficial, is 
the taking away of blood in a coniiderable quan- 
tity, and from a large orifice, from the arm, and 
even, in fome cafes, leeches or fcarifications may 
be ufed, for the purpofe of topical bleeding. 

tnftead of proceeding to detail particularly the 

mode of cure in a difeafe, in which the confequen- 

ces of failure are fo truly dreadful, and in the treat- 

Y ment 



1^8 MEDICAL ADMONITIONS* 

ment of which fo much knowledge and difcerii* 
ment are required ; I will offer a few words of 
advice, fuggefled by the mention of the firft mea^ 
fure neceffary to be adopted in the endeavour to 
obtain a cure. Bleeding, it has been remarked, is 
neceffary in this difeafe ; and frequently is this in* 
dicated to fuch an extent, as to excite alarm among 
the friends of the fick, who will too frequently 
remonftrate againfl what they will term, a farther 
wafte of blood. Let the confequence of this con- 
duct be confidered. The phyfician muft either per- 
fifl in obtaining a compliance with his prefcription, 
and fubmit to all the confequences of fcandal and 
mifreprefentation, in cafe of a fatal termination ; 
or, prompted by too much tendernefs for his char- 
acter and reputation, he may concede to the fears 
of the patients friends, and that which was nece£ 
fary to the patient will be omitted. As a phyfi- 
cian, it may be faid, would never give up a point, 
on which the life of his patient depended, no real 
injury can refult from this oppofition. But furely 
it will be allowed, that the man muft poffefs a con- 
fiderable fhare of fortitude, who will perfift in de- 
manding an exact compliance, in a cafe which, if 
all be done that art can do, may terminate in the 
death of the patient ; and where the friends of the 
fick fay, but in other terms, What you infill on 
feall- be adopted j but if the patient die, you mufi 

expect 



MEDICAL ADMONITIONS. 1 79 

expect all the obloquy,that can be heaped upon you. 

In no difeafe is a ftrjcl abflinance more neceffary, 
than in this ; fince, in proportion to the ncurifh- 
ment taken in, will be the increafe of the blood, 
and confequently of the difeafe. Nothing but 
watery drinks, as toaft and water, barley-water, 
pe&oral drink, bread tea, &c. rendered pleafant by 
the addition of the mildeft vegetable acids, ought 
to be allowed, until the violence of the difeafe is 
fubdued ; nor then mould the lighter kinds of 
noUrifhment, as panada, &c. be allowed, but in the 
moft cautious manner. ■ The drinks may be taken 
frequently, but in fmall quantities at a time, and 
never entirely cold. 

If the difeafe is not removed by the firft attempts, 
efpecially if two or three days of its duration have 
elapfed, fymptoms, fo ambiguous in their appear- 
ances, occur, as to require the greateft nicety in 
determining to what the indications point. Fre- 
quently it will be found neceflary to repeat the 
bleedings feveral times, and that even in the firft 
hours of the difeafe j but fometimes, when the ur- 
gency of fome of the fymptoms, may feem to indi- 
cate this repetition, other circumftances may occur, 
which may take away from the clearnefs of the indi- 
cation, and even feena to contradict it. Sometimes 
this difeafe terminates by expedoration,with reipecfc 

to 



l8d MEDICAL ADMONITIONS. 

to which much judgment is neceffary fince, where 
this proves to be the cafe, the future fafety of the 
patient will depend upon properly encouraging 
and regulating this difcharge. Sweating, although 
fometimes recommended, as proper to be promoted 
very early in the difeafe, yet we are taught, by a 
very great authority, that it ought not to be excited 
by art, unlefs with much caution. Much nicety is 
required alfo in the management of the cough, 
which often, by its feverity, very much diltreffes 
the patient, often occafioning a confiderable aggra- 
vation of the pain, and want of fleep. The exhibi- 
tion of opiates will mitigate this troublefome fymp- 
tom ; but it ought alfo to be known, that given 
in certain ftages of the difeafe, and without certain 
cautions, they will not only impede the cure, but 
prove injurious in a very high degree. 

• Convinced of the- difficulty in conducting this 
difeafe to a cure by any but profeflional men, I have 
intentionally avoided the talk of directing the man- 
agement of the difeafe through its whole progrefs. 
In confequence of that ambiguity, in which, it has 
been before obferved, the fymptoms are often in- 
volved, little benefit could arife, in a work of this 
kind, from the enumeration of the various reme- 
dies which different circumftances require ; fince 
even the exiftence of thefe particular circumftances 
is not always difcoverable, at leaft by domeftic prac- 

titionersi 



MEDICAL ADMONITIONS. l8l 

titioners.* An error in the treatment of this dif- 
eafe might be fucceeded by the mofl fatal confe- 
quences j fi'nce, if the patient fhould efcape fuddcn 
fuffocation, from an extravafation of blood in the 
cellular fubftance of the lungs, it is yet to be feared, 
left fuppuration fhould take place, and the unhappy 
patient fufter the lingering mifcries of an incurable 
consumption. 

One 

* Dr. Buchan, after enumerating the remedies proper in this 
difeafe, fays, "We have mentioned different things, on purpofe 
" that people may have it in their power to choofe ; and iike- 
" wife, that when one cannot be obtained, they may make ufe 
" of another. Different medicines are no doubt neceiTary in the 
" different periods of a diforder ; and where one fails of fuccefs, 
" or difagrees with the patient, it will be proper to try another." 
But in a difeafe fo dangerous in its nature, the vague and deful- 
tory praclice of domeftic medicine muft be very hazardous. 
For, as is well obferved by Dr. Duplanil, who has tranflated 
Dr. Buchan's Domeftic Medicine into French, and has added 
to it fome -excellent notes, in his obfervations on this paflage of 
Dr. Buchan's, " Cependent, nous ne pouvons difconvenir que 
" quelque nmple que fojt cette marche, ille demande une atten- 
" tion dont tout le monde n'eft pas capable, on a done raifon de 
*' dire que fi la regime eft fufceptible d'etre adminiftre par tous 
" les hommes, les remedes ne doivent l'etre que par les perfonnes 
" les plus prudentes and les plus eclairees." — "lNeverthelefs,we 
cannot deny, that however plain this path may be, yet it re- 
quires fuch attention as every one is not capable of giving. 
It may therefore with propriety be faid, that although the diet 
may be adminiftered by any one, yet medicines fhould not be 
prefcribed by any but the moft cautious and well informed." 



I§2 MEDICAL ADMONITIONS. 

One obfervation more muft be made, whiifl on 
this fubjecl:, fince there is net a doubt, that an 
attention to it may occafion the faving of many 
lives. It is to be remarked, in the hiftory of this 
difeafe, that in fome cafes very little change is per- 
ceptible in the ftate of the pulfe, or the temperature 
of the body ; and that the pain alfo may be but 
inconfiderable, giving an idea to the patient, rather 
of oppreflion than of pain ; fo that, excepting the 
difficulty of breathing, which may be referred to 
many other caufes, the patient will have few or no 
marks, by which he can be led to fufpeel: the nature 
of his complaint, and the danger of hisfituation, 
until he is out of the reach of help. It too fre* 
quently happens, that phyficians are called to the 
amftance of thofe, who will fay, fhat having expe- 
rienced little or no inconvenience, excepting a little 
difficulty in breathing, they had waited with the 
hope of its going off without any medical aid j and 
too often it is found, that the infidious difeafe has, 
in that time, injured the conftitution irreparably. 

In every cafe, where the breathing becomes 
changed from its natural ftate, without any evident 
caufe, a morbid change of the lungs may be reafon- 
ably fufpe&ed j and as this can never happen with- 
out endangering the life of the patient, the beft 
advice fhould be obtained, and as early as poflible. 

Great 



Medical admonitions. 183 

Great care mull be taken, after recovery from 
this difeafe, that a relapfe is not produced : the 
fpareft diet fnould therefore be ufed, the inclemen- 
cies of the weather carefully guarded againft, mod- 
erate exercife employed, and the cheft protected 
from the action of cold, by conftantly wearing a 
flannel waiftcoat next the fkin. All thofe circum- 
ftances defcribed as caufes of this difeafe fliould be 
carefully avoided. 



INFLAMMATION OF THE LUNGS IN 
CHILDREN, 

The prefent fection is written with the eager 
hope of calling the attention of parents to the firft 
appearance of inflammation of the lungs in chil- 
dren, fince its firft attack is, in general, made in fo 
infidious a manner, that little or no alarm is excited $ 
and the ravages of the difeafe are permitted, until 
they exceed all probability of reftraint. Indeed, 
the number of children loft by neglecting to oppofe 
this malady on its firft appearance, muft very far 
exceed the conjecture of any one who has not had 
the opportunity of witneffing the many deaths from 
this caufe. 

The firft fymptom difcoverable in children, is, 
In general, a flight degree of feverifli neat, which, 

m 



I84 MEDICAL ADMONlTIONb. 

in the courfe of a few hours, increafes, and is foori 
accompanied by a quicknefs of the breathing* 
This, however, is often hardly obfervable, requir- 
ing, even from thofe who are accuflomed to wit- 
nefs this difeafe, very nice attention to determine, 
whether the refpiration is morbidly increafed or 
not. If the difeafe Hill eludes the attention, and 
proceeds in its courfe, the heat increafes, a fhort, 
dry, hard, cough comes on, and the refpiration is 
not only more quickened, and becomes more labori- 
ous, but is performed with a rough whizzing found. 
The child is now in a confiderable degree of danger; 
but if, warned by this laft fymptom, immediate 
afiiftance be obtained, it may probably yet be fwed. 
Should this ftrong notice of danger pafs unheeded, 
and the means of relief be longer deferred, every 
exertion may be made in vain, and the child, after 
the fevereft ftruggles, die in the courfe of a few 
more hou*rs ; or gradually fall into one of the moft 
diftrefling ftates which a parent can witnefs — a gra- 
dual decline. 

Quicknefs of breathing, flight cough, and heat 

of the fkin, in children, mould therefore be always 

regarded as fymptoms demanding immediate invef- 

tigation. Since, although they may fometimes 

occur trithout danger, they moft frequently will be 

found to mark the exiftence of this alarming 

malady. 

When, 



Medical admonitions. 185 

"When, therefore, thefe fymptoms are met with* 
tinder the circumftances above mentioned, the dif- 
eafe appearing to be manifeft, and proper advice 
cannot be dire&ly obtained, a leech or two, accord- 
ing to the age and ftrength of the child, mould be 
put on the fore part of the cheft ; the child mould 
then be immerfed in a warm bath, up to the middle* 
or even to the arm-pits, from ten minutes to a 
quarter of an hour ; and then wiped dry, Wrapped 
in a blanket, arid placed in bed ; a blifter ihould be 
applied to the cheft, cloths ihould be properly dif- 
pofed to abforb the blood, which it is. to be hoped 
will continue to flow, and frequent warm fippingSj 
fuch as milk and water, barley-water, &c. fupplied, 
fo as to produce a copious flow of peffpiration, 
Generally, if thefe means be adopted, at this ftage 
of the difeafe, the breathing will, in an hour or two, 
diminifh in frequency j and, in about ten of twelve 
hours, eafy, natural refpiration will return* 

I have purpofely avoided mentioning the em- 
ployment of medicine, in thefe cafes, fince though 
thefe may be ferviceable in the higheft degree, when 
adminiftered with a due attention to every circum- 
fiance ; yet, as it would be impoffible to deliver 
fatisfadory rules for their exhibition, in all the cafes 
likely to happen, I have thought it right their ufe 
ihould be deferred, until due advice Can be obtained* 
I muft, however, add a word or two more refpe&- 
Z ing 



I 86 MEDICAL ADMONITIONS. 

ing fome of the means already fpecified, to prevent 
any error in their employment, by which we might 
be deprived of the advantages we expected from 
them. Much care is neceflary, that the water of 
the warm bath mould be nicely adjufted in its tem- 
perature ; by its effects being firft tried on the 
ufually uncovered part of the arm of the parent or 
nurfe : employing it only of fuch a degree of heat, 
as may be thus borne pleafantly. On the one hand, 
mould it be of a lower temperature than this, a 
fudden chill would pervade the fyftem, and every 
fymptom be immediately aggravated. So, on the 
other hand, if, deceived by the heat of the water, 
having been only tried by the hand, or by that j>art 
of the arm which, by conftant expofure, has become 
infenfible to frnall variations of heat and cold ; and 
not imputing the cries of the child to their real 
caufe, the too great heat of the water, the child be 
kept in water of too high a temperature, it will 
come out of the water with the fever and other 
fymptoms confiderably augmented, and inftead of 
perfpiration fucceeding, the fkin wiU become more 
parched than ever, and inflammation will be urged 
on with irrefiftible rapidity. In one inftance, of 
which I have been credibly informed, a child was 
actually fo fcalded, by want of due attention in this 
procefs, that blifters arofe in feveral parts of the 
body, during the few hours the child furvjved. 

Some 



MEDICAL ADMONITIONS. 187 

Some caution is alfo neceffary, in the application 
of the blifter to. the ftomach ; fmce, if fo placed, 
that the blood, proceeding from the wound made 
by the leech, be allowed to infinuate between it and 
the fkin, it will be found, when, perhaps, it is too 
late for its removal, that it has entirely failed, a 
coagulum of blood having completely defended the 
fkin from its action. 

It does not unfrequently happen, that parents, 
though warned of the danger which awaits a child ; 
and repeatedly advifed to adopt the propofed reme- 
dies, will not allow themfelves to be convinced of 
the neceffity of employing fuch violent means, as 
they will term them, for the removal of what they 
will alfo term, a trifling ailment. 

It will, by many, be hardly credited, that from 
the circumftance of deferring to fend for medical 
aid until towards the evening, the lives of many 
children are loft. The child appears rather unwell 
in the morning, the breathing becomes fhort in the 
courfe of the day, the feveriflmefs and cough alfo 
increaling ; and at the arrival of evening, fearing 
a difturbed night, the family apothecary is fent for, 
to provide a little draught to enfure a good night's 
reft. Struck with the dangerous fituation of the 
child, he endeavours to communicate his juft fears 
and anxiety to the parents j but however iurprifing 

it 



l88 MEDICAL ADMONITIONS. 

it may appear, his admonitions will often be Kfi 
tened to with incredulity, and even with unjuft 
fhfpicion. It appears to the parents, that too murh 
is about to be done ; the plan propofed, they ob- 
ferve, is very inconvenient, eipecially at that time 
of the evening. They therefore either plainly fay, 
they fhall wait 'till morning ; or they promife to 
employ the means, and afterwards change their 
minds ; fo that, when vifited in the morning, the 
child is perhaps found fo much worfe, as to render 
the probability of fuccefs, from even the moil ap- 
propriate means, very doubtful. It is not in this 
difeafe alone, that this fatal obftinacy of parents is 
found : every apothecary muft have repeatedly met 
with it, in thofe difeafes, in which the fymptoms 
are not of fuch a nature as to alarm the ignorant, 
and where the curative means are attended with 
any trouble, out of the ordinary way ; efpecially, 
too, if application for advice is deferred until the 
evening : which, putting all confideration of the 
eafe or comfort of medical men out of the queftion, 
and confidering only the benefit of the patient, and 
the convenience of thofe around him, ought never 
to be done. 



PULMONARY 



MEDICAL ADMONITIONS. 1 89 

PULMONARY CONSUMPTION, 

OR - 

ULCER OF THE LUNGS. 

The chara&eriftics of this difeafe are, hectic fever, 
cough, and a fpitting, chiefly compofed of matter. 

A confumption may fucceed to catarrh, afthma, 
inflammation of the lungs, and fpitting of blood : 
it may alfo proceed from tubercles formed in the 
lungs. Sometimes it is induced by a general affec- 
tion of the fyftem : moft frequently it is accompa- 
nied by a fcrophulous habit ; and fometimes it is a 
confequence of the venereal difeafe, the mealies, or 
the fmall-pox. 

Thofe artificers who inhale great quantities of 
duft from the bodies which are the fubjects of their 
operations, fuch as leather-dreffers, flax-dreffers, &c. 
are faid to be particularly liable to this malady. 
The perfons moft difpofed to this difeafe are thofe 
of a fair complexion, florid cheeks, flender make, 
narrow cheft, prominent fhoulders, and a long neck. 

The firft appearance of the difeafe will vary in 
different cafes ; this variety depending, in a great 
meafure, on the nature of the preceding difeafe. 
The moft conftant fymptom, however, is a cough, 
by which phlegm is frequently thrown up : this 
phlegm becomes,by degrees, more thick and opaque, 

refembling 



I90 MEDICAL ADMONITIONS. 

refembling matter ; of which, at length, it becomes 
almoft entirely compofed. The breathing is, in 
general, from the firft, fliort and laborious ; and 
accompanied with a tightnefs acrofs the cheft, as 
though the cheft was confined with a cord. Some- 
times painful ftitches are felt in various parts of the 
cheft ; and, almoft in every cafe, the patient's 
breathing is rendered worfe by laying down in bed. 
It frequently alfo is obferved, that much greater 
inconvenience is experienced by laying on one fide, 
than on the other. The cheeks are often flufhed, 
and a heat is felt in the palms of the hands and foles 
of the feet, which increafes as the evening comes, 
on. After a little time, this heat becomes more 
diffufed, affecting the whole fyftem with febrile 
fymptoms ; thefe generally come on about the mid- 
dle of the day, being commonly preceded by a flight 
rigor or chillinefs j and, after continuing two or 
three hours, fubfide, but return as the evening 
advances. The heat and thirft then becomes excef- 
five, the breathing is quicker and more laborious, 
the cough more frequent and dry, and the difcharge 
of phlegm leffens, as the heat increafes. In this 
reftlefs and diftreffed ftate, the patient paffes his 
nights. As the morning appears, a profufe fweat 
generally comes on, which, after continuing an 
hour or two, gradually goes off, leaving the patient 
in a very languid ftate. 

The 



MEDICAL ADMONITIONS. IQj 

The difeafe, in fome cafes, will remain nearly in 
the fame ftate, for feveral weeks, or even months 5 
the fymptoms, all this time, increafing very flowly, 
and the patient alternating between hope and def- 
pair, the former, however, in general prepondera- 
ting. In other cafes, the difeafe proceeds more 
rapidly, the fpit increafing very much, and becom- 
ing of a thicker confiftence, and moftly of a yellow 
colour. As the difeafe becomes more inveterate, 
the fpit acquires a greenifh hue, the fever increafes ? 
and the fweats become exceedingly profufe. The 
patient is, at this period of the difeafe, confiderably 
wafted, his nails curved inwards, his feet and legs 
fwoln, his countenance ghaftly, the eyes appearing 
to be funk in their fockets, the jaw-bones appearing 
more elevated than natural, and a crimfon glow 
frequently appearing on the cheeks. In this ftate 
the patient does not continue long, before apthous 
ulcers in the throat and mouth, or a frequent col- 
liquative purging, Ihews, that the fatal termination 
of the difeafe is near at hand. 

No period* of life, from childhood to old age 
itfelf, is exempt from this difeafe ; but the moft fre* 
quent fubje&s of it are, the young and the middle 
aged. 

The treatment of this difeafe muft, even at its 
commencement, differ very much in different cafes : 

this 



tgi MEDICAL ADMONITIONS. 

this variety of treatment chiefly depending on the 
nature of the preceding, or accompanying difeafe. 
Befides this, it is obvious, that a difference in the 
treatment muft be required, according to a period 
of the difeafe at which the cure is attempted. To 
obtain benefit from medicine, in this difeafe, much 
judgment is required to be exerted ; fince very evil 
confequences may follow the ufe of a medicine at 
one period of the difeafe, which, if ufed at another, 
might prove of the greateft benefit. On the part 
of the patient, is required the ftri&eft regularity, 
and moft earneft perfeverance ; fince the beft calcu- 
lated means can have but little chance of effecting 
any confiderably beneficial change, unlefs perfevered 
in for a confiderable time. 

From medicines alone, there is, however, but 
Very little to be hoped for, in this difeafe ; their 
effects muft be feconded by a ftricl: attention to 
various circurnftances, in the patient's mode of liv- 
ing ; fuch as his diet, exercife, clothing, &c. Of 
fuch importance, in the cure of this difeafe, is a 
careful attention to thefe circumftances^ that the 
probability of recovery would be much greater, in 
trufting entirely to a due regulation of thefe, than 
to medicine alone. 

As medicine can only be trufted to, in this dif- 
eafe, when in the hands of medical men, and as a 

proper" 



MEDICAL ADMONITIONS. 1 93 

proper regimen, is effehtial to the cure, and depends 
fo much on the patient himfelf, and his attendants, 
I fhall dwell more fully on this article. 

The diet fhould be compofed of fuch things as 
are fufficiently nourifhing ; and as are likely, by 
their mild and antiseptic nature, to correct any 
prevailing acrimony, and diminifh the difpofition 
to inflammation. The lofs of flefh, and the extreme 
languor which generally takes place, too frequently 
induce the friends of the lick, with the hope of 
recruiting his impaired vigour, and wafted habit, 
to fupply him with food of the moft highly nour- 
ifhing kind, with wine, and even fpirituous liquors; 
and this, efpecially, when long indulged habits ren- 
der the demands of the patient importunate. But 
as the cafes are very rare indeed, where thefe indul- 
gences will not aggravate every fymptom, and 
accelerate the fatal termination of the difeafe ; they 
muft not be permitted on every weak and trifling 
argument, which the patient may adduce. 

This caution is the more neceffary, fince, where 
inclination is ftrong, reafons, light as air, are pro- 
duced as the oftenfible motives for a deviation from 
the rules laid down by the phyfician : but the friend, 
or the phyfician, who, through too much complai- 
fance, allows any weight to fuch arguments, by no 
means fulfils his duty. 

A a Di\ 



1C>4 MEDICAL ADMONITIONS. 

Dr. Buchan, when treating of the regimen iil 
this difeafe, fays, " We do not, however, advife 
" thofe, who have been accuftomed to animal food 
" and ftrong liquors, to leave them off all at once." 
But I cannot help fufpecKng, that this advice, in a 
work addreffed to patients themfelves, may fre- 
quently prove injurious, by allowing too great a 
latitude. For although the Doctor, aware of the 
ill cohfequences of neglecting a due attention td 
regimen ; and doubtlefsly with a view of prevent- 
ing the evils which improper indulgences may occa- 
sion, recommends, at firft, wine to be drank diluted 
with twice or thrice its quantity of water ; yet as 
wine generally turns four ort the ftomach of thofe 
who are devoted to the pernicious cuftom of drink- 
ing fpirituous liquors ; it is much to be feared, that 
fuch perfons will be likely to prefume On this advice, 
of not leaving them off all at once ; and will fubftitute, 
for the wine, a little of that to which they have 
hitherto been fo much accuftomed. There appears 
to me two powerful reafons, why this change mould 
be undertaken, refolutely, at once. In the firft 
place, as the cure of the difeafe depends on a certain 
change being made in the conftitution, the more 
expeditioufly this change is brought about, the 
greater the probability muft exift of its effecting a 
cure. Since, during the time occupied by the en- 
deavour to produce a gradual change, the chance 

of 



MEDICAL ADMONITIONS. 1 95 

of recovery may be entirely loft, by the accumulated 
forces the difeafe may obtain. In the fecond place, 
there is little or no chance of favourite habits being 
overcome in this gradual manner ; the only mode 
of obtaining a vi&ory, being by a refolute and firm 
refinance ; every little indulgence allowed, like 
ground yielded to an enemy, tending, in general, to 
leffen the power of oppofing his attacks. Dr. Cad- 
ogan, when pointing out the neceffity of a iimilar 
abftinence, in gouty perfons, and the difadvantages 
of attempting to do it by degrees, very juftly ob- 
serves, " But the danger of attempting it in this 
" manner is, that it will never be done ; and, like 
" a procraftinating iinner, he will for ever put off 
" his penitential refolution 'till to-morrow. If he did 
" it all at once, I would be hanged if he died of the 
^ attempt ; he would be uneafy for three or foU£ 
^ days, that's all." 

The argument for good living, which in this cafe 
is commonly adopted by patients, and their friends, 
is induced from the weak ftate which accompanies 
the difeafe ; and from obferving the reftorative 
effeds of highly nourifhing food, injthofe cafes of 
temporary defection of ftrength, produced by long 
failing, violent labour, or long continued exercife, 
of any kind ; thence they fuppofe, that no method 
is fo likely to remove the patient's extreme languor; 
^s the Supplying him, freely, with thofe things, 

which 



I96 MEDICAL ADMONITIONS. 

which in health appear to be the fource of ftrength 
and vigour. As it cannot be expected, that the 
directions of phyficians will be implicitly obeyed, 
when the opinion of the patient and his friends im- 
mediately militate againft them ; the pointing out 
the fallacioufnefs of thofe opinions becomes necef- 
fary. This failure of ftrength, and wafting of the 
body, then, it muft be underftood, do not proceed 
from a deficiency of aliment, but are the neceflary 
confequences of a difeafed ftate of the fyftem ; and 
are only to be remedied by altering that peculiar 
ftate : until this be done, no advantage will refult 
from any extraordinary fupply of food- 

The neceflity of thus regulatingthe patient's food, 
is rendered obvious, by the farther confideration, 
that foon after every meal, the hectic fever, the 
conftant attendant on this malady, is always, for a 
time, augmented ; the increafe being greater, when 
the food is highly nutritive and ftimulant, but lefs, 
when it is light and mild. 

The diet muft, therefore, almoft entirely, confift 
of milk and vegetables ; by blending which, an 
agreeable variety may be obtained. For breakfaft, 
the patient may have milk, frefh from the cow ; or, 
if it ftiould prove offenfive to the ftomach in this 
ftate, it may be deprived of its cream. With the 
milk, may be eaten bifcuits, or toafted bread, either 
dry, or fpread with honey, or the jelly or marmal- 
ade of fruits. E> r - 



MEDICAL ADMONITIONS. I gj 

Dr. Buchan fays, " If it (the milk) mould, not- 
< c withftanding, prove heavy on the ftomach, a fmall 
*' quantity of brandy, or rum, with a little fugar, 
" may be added, which will render it both more 
"light and nourifhing." The late Dr.Fothergillvery 
juftly obferved, " There is one ufual addition made 
" to milk, which, I think, mould be either wholly 
',' profcribed, or the moft exprefs directions given 
" concerning it, 1 mean the common addition of 
" brandy or rum to affes or cows milk." — Ardent 
fpirits, he obferves, occafion the milk to difagree, 
and augment the difeafe. 

Boiled bread and milk, water-gruel, . and milk- 
pottage, are very proper j and, if more agreeable, 
may be fubftituted for what has been already recom- 
mended. For dinner, a tolerable extenfive range 
may be afforded the patient, in the various fruits, 
and other vegetable productions of the feafon. 
Apples drefled in different ways, turnips, afparagus, 
lettuces, dandelion, potatoes, parfnips, rice boiled 
into a pudding, either alone, or with the addition 
of an egg and milk, and puddings of various kinds, 
form a bill of fare, within the bounds of which, no 
one, furely, will refufe to confine himfelf, when it 
yields him almoft the only chance of a reftoration 
to health. For fupper the patient may have falop, 
fago, tapioca, panada, or any of thofe articles whicfy 
have been recommended as proper for breakfaft. 

The 



j 98 medical Admonitions. 

The drinks through the day may be, butter-milk v 
fweetwort, affes milk, goats milk, barley-water, pec- 
toral drink, &c. 

I mean not to affert, that animal food is, in every 
cafe, to be ftrictly prohibited, or to deny that there 
may be cafes, in which its ufe may be advifable. 
But thefe are fituations which are only to be pointed 
out by a thorough knowledge of the difeafe, and 
of the general ftate of the fyftem. 

The kind of exercife, and the degree to which it 
is ufed, at the commencement of this malady, muft 
depend on the manner in which the firft attacks 
were made. Thus, if it has been preceded by fpit- 
ting of blood, or by confiderable inflammation of 
the lungs, the exercife employed muft be of the gen- 
tleft kind. But when the difeafe is produced by a 
long continued cough, or repeated catarrhs, exercife 
may be ufed to a greater extent. The necefuty of 
this difference exifts, however, only in the firft ftage 
of the difeafe ; for after the difeafe is once formed, 
the fame rules for exercife will be proper in almoft 
every cafe. 

A general maxim for the regulation of exercife 
in this difeafe is, that it be never employed to iuch 
a degree, as that the heat of the body be much 
increafed by it, or that it induce much fatigue. 

As 



MEDICAL ADMONITIONS. I99 

As the chief intention of exercife, in- this difeafe, 
is to obtain the application of pure and frefh air to 
the lungs, it is evident, that the kind of exercife^ 
moft likely to anfwer the intention, is that by which 
the patient is conveyed from one place to another^ 
fuch as walking, riding, failing, &c. 

Walking, in confequence of its quickening the 
circulation of the blood, and fo foon inducing fa- 
tigue, is the kind of exercife leaft likely to prove 
beneficial in thefe cafes, and mull be had recourfe 
to with great caution. 

Riding on horfeback, is an exercife, in many 
refpe&s, much preferable to walking ; as the patient 
is, by this means fooner conveyed into a more 
pure and falubrious atmofphere, and is, at the fame 
time, able, by regulating the pace of his horfe, to 
adapt his exercife to his ftrength, and to his ability 
of bearing it. But the exercife of riding, as well 
as that of walking, requires fome exertion on the 
part of the patient, and therefore is not admiffible,, 
except with the great eft caution, in thofe cafes where 
there exiftsa fufpicioh of inflammation* or impend- 
ing hemorrhage. 

In thofe cafes where the expofiire to the open 
air is neceffarvj but where weaknefs, or any other 
circumftance, renders it neceffary that this mould be 
done with the leaft poffible exertion, recourfe mufl 

be 



200 MEDICAL ADMONITIONS^ 

be had to the conveyance of a carriage ; which may- 
be more or lefs open, according to the mildnefs or 
inclemency of the weather. 

The mode of conveyance, which is to be preferred 
to all others, when no injury is likely to be induced 
by the violent exertions attendant on fea-ficknefs, 
is that of failing ; fince here the patient may enjoy 
the benefit of a fucceflion of frefh and falubrious 
air, whilft the body is exercifed in the raoft regular 
and equable manner ; at the fame time, the patient 
may farther exercife himfelf, to the degree that his 
ftrength will admit, and his cafe require. 

Where the benefit of failing, or of a carriage, 
cannot be obtained, and where the exercife of walk- 
ing or riding on horfeback, is not adtniffible, 
fwinging is a mode of exercife which may be em- 
ployed with the greateft fafety and advantage. 

It is not fufBcient that the patient breaths air 
that is frefh, and untainted with noxious vapours ; 
it is alfo neceffary, that the atmofphere, to which 
he is expofed, be temperately and uniformly warm. 
At the approach, therefore, of cold weather, the 
patient mould remove to a Warmer climate ; vary- 
ing the fituation, according as the viciflitudes of 
the feafons may render it neceffary. The advanta* 
ges to be derived from a change of climate, in thefe 
cafes, are fo great, that, when joined with due 

reftrictions 



MEblCAL ADMONITIONS. 201 

reftriclions as to diet, it fometimes accomplices a 
cure, in cafes where medicine alone would have 
been of no avail. 

It has been remarked, that the inhabitants of 
this ifland are particularly liable to this difeafe ; 
and this has been faid to be owing to the frequent 
and fudden changes in the weather, and the almoft 
conftant predominance of moifture in the atmof- 
phere. A removal to a more temperate climate, 
where tjie transitions of the weather are lefs confid- 
erable, and lefs fudden, is therefore particularly 
neceffary, for fuch as have reafon to appxehend 
even a difpofition to this difeafe. 

Air, extremely pure, is not, however, in this 
difeafe, always proportionally falubrious ; on the 
contrary, it has been found, that, in fome cafes s 
advantage has been obtained from breathing an 
atmofphere more impure than the common atmof- 
pheric air. 

Experiments fhew, that the atmofpheric air con- 
tains two different airs ; the one termed vital or 
oxygen air, which fupports refpiratioh and combuf- 
tibn ; the other called azotic air, in which combuf- 
tiori foon ceafes, and animals quickly die. 

An animal being confined under a glafs, with a 

certain quantity of atmofpheric air, will foon die : 

B b and 



202 MEDICAL ADMONITIONS. 

and the air remaining in the glafs being examined, 
it will appear, that the oxygen is confumed, and that 
the glafs now contains azotic air, and fixed, or car- 
bonic acid air. Experiments alfo prove, that this 
change has been thus effected — the blood, which 
arrives at the lungs of a dark colour, parts with 
the carbon, or charcoal, it contains, which, uniting 
with one part of the oxygen, forms the carbonic acid 
air. Another part of the oxygen unites with the 
hydrogen or inflammable air, which is feparated from 
the blood, and with it forms the humid vapour that 
iffues from the mouth. The other part of the oxygen 
is imbibed by the blood in the lungs, which it ren- 
ders of a bright red colour. Thus abforbed, the 
oxygen becomes a general ftimulus to . the whole 
animal fyftem. 

Poffeffed of this knowledge, feveral intelligent 
phyficians have employed the two conftituents of 
atmofpheric air, in various proportions, in differ- 
ent difeafes. By this they have difcovered, that 
by breathing an increafed proportion of oxygen, the 
infenfible perfpiration is increafed, digeflion is 
quickened, the animal heat and the mufcular pow- 
ers are increafed, and the refpiration rendered eafy; 
and that by breathing air in which azotic air pre- 
vails, febrile heat is moderated, and morbid action, 
efpecially in the finer veffels of the lungs, is re- 
trained. 

Oxygenated 



MEDICAL ADMONITIONS. 203 

Oxygenated air has been fuccefsfully employed in" 
putrid fever, afthma, dyfpnoea, chlorofis, dyfpepfia, 
ulcers of the leg, fcurvy, and other difeafes, by Drs. 
Beddoes, Thornton, Carmichael Smyth, Darwin, 
Ferriars, Pearfqn, &c. Azotic air, and chiefly air 
termed the hydrocarbonate i has been fuccefsfully ap* 
plied, by the fame gentlemen,. in pleurify, croup, 
catarrh, fpitting of blood, and even in confump- 
tion. 

Hence,then, it appears, that fo far from a remo- 
val into the pure air of the country, being indicated 
in every cafe of confumption; that cafes muft often 
occur, (thofe where inflammation prevails,) in 
which the air, even of a crowded city, maybe pre- 
ferable. 

Pulmonary confumption is a difeafe, to which 
thofe who are afflicted with a fcrophulous habit are 
particularly difpofed ; and is, undoubtedly, very 
frequently the confequence of fuch a difeafed habit,, 
where, however, there may not be any other very 
obvious mark of its exiftence. The benefit arifing 
from the fea air, in fcropulous cafes, is well known, 
and points out another reafon for preferring failing 
to any other exercife, or mode of conveyance. 
Still, however, remembering, that if the patient be 
liable to very violent exertions from fea-ficknefs ; 
and cannot, by proper accommodation, obtain an 

entire 



2Q£ MEDICAL APMONITIQ^S. 

entire exemption from the injurious effects of cold 
and rain, more injury than advantage may follow 
from a fea-voyage. 

In confequence of the application of cold and 
moifture to the fkin, the innumerable veflels difpo- 
fed on the furface of the body become conftricted, 
and the blood is driven back on the internal parts ; 
inevitably occafioning additional injury to thofe 
organs, which are already difeafed, and unable to 
bear an additional load. To prevent this from 
taking place, the utmoft care muft be taken in the 
choice of the patient's clothing, which mould be fo 
contrived, as to defend the furface from the aftion 
of cold, and, at the fame time, fupport a free cir- 
culation through the extreme veflels. Flannel 
worn next the fkin, is of the utmoft fervice in thefe 
refpects, fince, by exciting a flight irritation on the 
fkin, it occafions an increafed determination of 
blood and heat to the furface ; by which the inter- 
nal parts are, of courfe, relieved. Befides this, it 
allows the accumulation of heat to take place more 
abundantly on the furface of the body, than would 
be the cafe, if linen, or any other fubftance of a 
clofer texture, were worn. Nor is it liable, if ren- 
dered damp by perfpiration, to occafion cold chills, 
when re-applied to the fkin, after having been a 
little feparated from it ; a circumftance which can- 
not fail but take place, when linen clothing is worn 
next to the fkin. In 



MEDICAL ADMONITIONS. 'ipj 

In, thofe cafes, where the irritation or\ the fur- 
face is not defirable, and where the perfpiration is 
confiderable, the fleecy hofiery will be $oun4 to be 
more pleafant and beneficial than the flannel. 

The clothing muft, in general, be light, but warm. 
The cheft, in particular, fhould be well defended 
from the colcl, and the feet from the damp.. 

By a Ariel: attention to the above-mentioned di- 
rections, cafes, which otherwife might prove fatal, 
may frequently be brought to a favourable termi- 
nation. To expect- fuccefs, however, it is neceuary 
that thefe regulations be adopted in the early ftages 
of the difeafe, and perfevered in with the ftricteft 
conformity, for a coufiderable time. 



INFLAMMATION OF THE STOMACH. 

In this diftrefsful and ( dangerous malady, there 
is an acute burning pain in the region of the ftom- 
ach, vomiting, and fever. Exceflive thirft and reft- 
Jeflnefs alfo harrafs the patient. The pulfe is fmall, 
hard, and quick, and the debility and languor ex- 
ceeds that which accompanies almoft any other cafe 
"of inflammation. The breathing is performed with 
confiderable pain, and the region of the ftomach is 
extremely tender to the touch. If the difeafe is 
not fubdued, hiccup, delirium, and convulfions, 

foon 



206 MEDICAL ADMONITIONS. 

foon come on, and with coldnefs of the extremi- 
ties, and clammy fweats, point out that death muft 
inevitably fucceed. 

Inflammation of the ftomach may be occafioned 
by acrid, or hard and indigeftible fubftanees, taken 
into the ftomach, and drinking extremely cold 
liquors whilft the body is in a heated ftate. It may 
be alfo produced by various internal caufes, as well 
as thofe general caufes of inflammation before re- 
cited. 

Among the moft powerful caufes of this difeafe, 
may be confidered the fuddenly pafling from a cold 
atmofphere into warm rooms. Of the evils which 
may be thus produced, I have indeed already fpoken 
fully ; but the leflbn cannot be too ftrongly im- 
preffed, and the following opinion, from fo refpec- 
table an authority, ought not to be here omitted. 
Dr. Crichton, fpeaking of the evils arifing from 
tranfitions from cold to heat, fays, "It may be re- 
marked, that almoft all the cafes of inflammation of 
the lungs or ftomach, to which the common people 
of London are fubjecl, arife from fimilar caufes. 
Either they have been riding in carts, or on the 
tops of coaches, in very cold weather, and after- 
wards have come into a warm room, probably an 
alehoufe ; or elfe they have been working for hours 
in drains, or in fimilar cold iituations. While they 

remain 



MEDICAL ADMONITIONS. 20? 

remain in the cold, no fymptoms of the diforder 
occur. It aim oft always commences when they get 
home."* 

The ftomach may be affe&ed with that fpecies of 
inflammation termed phlegmonic, or with that 
which is of an erifypelatous kind. The hiftory 
which has been jtift given, defcribes the progrefs of 
the former, which is an acute difeafe : the exift- 
ence of the latter, is generally made known by the 
appearance of the following fymptoms. In the 
beginning, a moderate degree of pain, and a fenfa- 
tion of heat, is experienced at the pit of the ftom- 
ach. A naufea, and fometimes retchings, are pro- 
duced by the taking any fubftance into the ftomach j 
an increafe of the pain always being excited, in 
proportion to the degree of acrimony which the 
fubftance poffeneg. As the difeafe proceeds, the 
pain commonly increafes ; feldom, however, becom- 
ing exceedingly acute, but fometimes teizing the- 
patient for a confiderable time. Thirft, and a fre- 
quency of the pulfe, are in general alfo obfervable j 
but oftentimes the general ftate of the fyftem will 
be very little affected. This kind of inflammation 
has been frequently known to extend into the 
throat, and even to reach to the internal furface of 
the mouth, and fometimes it has occupied fuccet 
ftvely the whole trad of the inteftines. 

The 

* Inquiry into the Nature and Origin of Mental Derange- 
ment, vol. 1. p. 29. 



2o8 MEDICAL ADMONITIONS. 

The benevolent family practitioner will necefla- 
rily perceive, that fuch an affection of fo important 
an organ as an acute inflammation of the ftomach. 
is too replete with danger to allow him to attempt 
to conduct the patient through the whole courfe of 
this difeafe. A regular plan of cure is therefore 
not intended to be here delivered, but only fuch 
obfervations as may be likely to prove of benefit. 
and which cannot occafion any mifchievous error. 

A violent pain in the region of the ftomach, with 
ficknefs and fever, ihould be always very ferioufly 
attended to ; and if regular medical advice cannot 
be directly obtained, the patient mould be copioufly 
bled from the arm, the bowels emptied by means 
of a clyfter of water-gruel or weak broth, and a 
blifter be applied immediately over the pained part. 
The patient fliould be immerfed in a tepid bath, all 
his drinks mould be given lukewarm, and the tak- 
ing any thing poflefling the leaft acrimony care- 
fully avoided. 

Should the difeafe be confiderably mitigated by 
thefe means, yet the aid of the regular phyfician is 
abfolutely neceffary, as it will ftill require the ut- 
moft vigilance and care to prevent a relapfe. Great 
danger would follow, if the patient, milled by a 
deceitful truce, ihould, by omitting a due attention 
to thofe things which may be beneficial or inju- 
rious 



MEDICAL ADMONITIONS. 200 

rious, occafion a return of the difeafe ; fince the 
patient, weakened by the previous difeafe, and the 
remedies by which it had been removed, is but lit- 
tle able to fupport thofe evacuations which again 
become neceffary* 

When the difeafe is, to all appearance, entirely 
removed, the greateft care will be necelfary for a 
confiderable time afterwards, left a relapfe mould 
be induced. For this reafon, thofe circumftances 
which were enumerated, when fpeaking of the 
caufes of this inflammation, muft be ftudioufly 
avoided ; particularly the palling fuddenly into a 
much warmer or much colder temperature. A 
flannel waiftcoat worn next the fkin may prove 
highly ferviceable, by defending the convalefcent 
from thofe vici'flitudes of weather to which he muft 
necefTarily be expofed. 

In the other fpecies of this difeafe, which is evi- 
dently more of a chronic kind, the length of its 
duration will always allow of application to the 
regular profeffor of the healing art ; which, in this 
complaint, ought never to be precluded by the ex- 
periments of the ignorant. This difeafe is always 
accompanied by extremely troublefome, and fre- 
quently by dangerous, fymptomsL; and which, fo 
far from decidedly pointing out the nature of the 
difeafe, are generally fo ambiguous, that much fkill 
C c » is 



2IO MEDICAL ADMONITIONS. 

is required to detect it. Whenever, therefore, aiiy 
one is attacked with complaints, fimilar to thofe 
laid down in the hiftory of this difeafe, fpeedy ap- 
plication fhould be made for medical afliftance. 

During the procefs for the cure of this difeafe, 
and even for a confiderable time afterwards, the 
fame cautions are requifite, as were mentioned 
when fpeaking of the other fpecies. 

An affection of the ftomach, in which confidera- 
ble pain is experienced, from the confinement of 
air in this bowel, will not be eahTy diftinguifhed, by 
a common obferver, from inflammation. This is 
a diftin&ion, which is, however, abfolutely necef- 
fary to be made ; fince the mode of cure required 
in the two cafes are widely different. Should the 
patient, or his attendants, be mi-fled, and have re- 
courfe to fpirituous and aromatic liquors, in in- 
flammation of the ftomach, fuppofmg the difeafe 
to be occalioned by an accumulation of wind, a 
fatal termination of the difeafe will be moft rapidly 
produced. 

The naufea and urgings to vomit, may be fome- 
times the caufe of a miftake, pregnant with the 
greateft danger ; for upon a fuppofition that fome 
offenfive matter is contained in the ftomach, an 
emetic is frequently given, which muft neceflkrily 
be productive of a considerable- increafe of the in- 
flammation. INFLAMMATION 



MEDICAL ADMONITIONS. 211 

INFLAMMATION OF THE BOWELS. 



An acute, fixed, burning pain, with a confidera- 
ble degree of tenfion of the belly, obftinate coilive- 
nefs, hard and fmall pulfe, with fever, are the 
fymptoms which chara&erife this dreadful malady. 

This difeafe commences, generally, with flight 
wandering pains in various parts of the belly ; but 
which generally become fixed, about the region of 
the navel. Soon after this, the pain becomes ex- 
ceilively violent, as though caufed by the applica- 
tion of fome burning fubflance to the bowels ; the 
belly becomes fwelled, tenfe, and extremely tender 
to the touch j the tongue is parched, and of a dark 
brown colour, and the thirft unquenchable : fre- 
quent and violent urgings to vomit come on ; the 
urine is pafled but feldom ; and but feldom is any 
difcharge of faeces obtained, in fpite of the greateft 
efforts. The pulfe is hard, but fmall. The fever 
is, in general, acute ; in fome cafes, being obferva- 
ble before the coming on of the pain, and, in others, 
not until afterwards. If efficacious remedies are 
not had recourfe to, gangrene foon comes on. 
This is known to be the cafe, by a fudden ceflatioi* 
of the pain ; from which the patient, and his at- 
tendants, are fometimes difpofed to derive flatter- 
ing expectations : but the funk countenance, and 
fluttering pulfe, with convulfions, and coldnefs of 
the extremities, foon fhew what; fatal termination 
has taken place. This 



212 MEDICAL ADMONITIONS. 

This defcription would, perhaps, be fufficient to 
enable any one to difcover the nature of this dif- 
eafe, at its firft appearance ; but that it fometimcs 
exifts, according to the greateft authorities, with- 
out being marked by thofe fymptoms, which arc, 
in general, its diftinguifhing criteria. Thus direc- 
tions have fhewn, that inflammation of the bowels 
has exifted, and terminated in gangrene, where 
neither fever nor pain had been perceived, but in 
a flight degree. 

Inflammation of the bowels may fometimes, at 
its commencement, be not immediately diftin- 
guifhed from that of the flomach, or liver ; but 
this is not of much importance, fmce the means of 
cure necefiary to be adopted, at the firft, in either 
of thefe cafes, would be beneficial in all. 

The moll dangerous error, with refpeft to the 
treatment of this difeafe, is when it is miftaken for 
colicky pains ; to which family practitioners gene- 
rally refer almoft every painful affection of the belly. 
The remedies, which are almoft always had re- 
courfe to, on thefe occafions, are aromatic, fpiri- 
tuous, and heating liquors, under the delufive titles 
of colic elixirs, family cordials, &c. Thefe, it is 
evident, muft neceflarily accelerate the termination 
of this difeafe, in mortification. 

This difeafe may be occafioned by the fame cau : 

fcs. 



medical' admonitions. 213 

fes which were recited, when treating of inflamma- 
tion of the ftomach. It may alfo be the fequel of 
other difeafes, as of hernise, cofiivenefs, dyfentery, 
worms, &c. 

If the pain, before the difeafe has exifted long, 
changes its Situation, and becomes lefs violent j if 
the vomitings leflen, and llools are procured ; if 
the heat leffens, and the pulfation of the artery at 
the wrift feems to expand, it may be expe&ed, that 
a refolution is taking place. But if the pain increa- 
fes, and keeps conftantly in one point, and the belly 
becomes more tenfe and tender to the touch 5 if 
no ftools are obtained, and the vomitings come on 
more frequently, and contain flercoraceous matter, 
it is too evident that the difeafe is increaling ; and 
fhould fudden ceflation of the pain, hiccups, clammy 
fweats, blacknefs of the tongue, fallen countenance, 
and coldnefs of the extremities, occur, thefe fymp- 
toms will evince that death is very near. 

No apology can be neceffary for declining to 
give a regular plan, for the treatment: of this dread- 
ful difeafe ; fince no directions, however explicit, 
could fufHce to enable thofe, who do not poffefs 
-real medical knowledge, to make the neceffary dis- 
criminations, in inveftigating the nature of the 
malady, arid in felecling proper remedies for its re- 
moval. 

Every 



J 14 MEDICAL ADMONITIONS. 

Every painful affection of the belly, however 
flight, fliould be immediately attended to. If the 
belly become fwelled, hard, and painful to the 
touch ; and the pulfe hard and contracted ; blood 
fliould be taken freely from the arm, and the pa- 
tient put into the warm bath, about the fame tem- 
perature as the fkin ; or, if this cannot be conve- 
niently done, flannels wrung out of hot water 
fliould be applied to the belly, until a blifter can be 
procured ; which fliould be applied as foon as pof- 
fible after the bleeding. Mild emollient clyfters, of 
barley-water, gruel, &c. may be given, until ftools 
are obtained ; and the patient be put to bed be- 
tween the blankets, and fupplied moderately with 
the moft bland diluting liquors, fuch as barley-wa-. 
ter, gruel, rice-gruel, &c. 

. Dr. Buchan recommends, that "The clyfters may 

" be made of barley-water, or thin gruel, ivithfalt." 

But Dr. Duplanil, the tranflator of Domeftic Medp 

icine, remarks, " Plus les douleurs font violentes, 

" plus Tinflammation eft confiderable, & plus les 

" remedes doivent etre adouciflants. Les lavements 

<e avec le fel ne doivent done etre donnes, qu'avec 

" circonfpe&ion. ,, — The more violent are the pains, 

the more confiderable is the inflammation, and the 

more appeafing ought the remedies to be. The 

clyfters with fait, ought therefore not to be given, 

but with circumfpection. 

During 



MEDICAL ADMONITIONS. 215 

During the time that is employed, in the ufe of 
the above-mentioned means, proper advice may be 
obtained ; for which reafon, and as the utmoft 
caution is neceffary, in determining what internal 
remedies may be ventured on, they are not here 
enumerated. 

Dr. Buchan, whilft treating of inflammation of 
the bowels, fays, "It has fometimes happened, after 
" all other means of procuring a ftool have been 
" tried to no purpofe, that this was brought about 
" by immeriing the patient's lower extremities in 
" cold water, or making him walk upon a wet 
" pavement, and darning his legs and thighs with 
" the cold water. This method, when others failj 
" at leaft merits a trial. It is indeed attended with 
" fome danger ; but a doubtful remedy is better 
" than none." In cafes of obftinate coftivenefs, 
where there is no reafon to fuppofe that any in- 
flammation exi{ts, this experiment may be tried : 
but in this difeafe, no circumftance can warrant 
the adopting this practice ; fince there cannot be a 
doubt, that by this application of cold, the blood 
will be driven from the lower extremities, and be 
afterwards thrown, in an increafed quantity, into 
the veflels of the difeafed part, occafioning, not 
only an increafe of the inflammation, but, in all 
probability, a rapid termination of it in gangrene. 

Similar 



2l6 MEDICAL ADMONITIONS. 

Similar cautions, with thofe which were recom- 
mended, at the clofe of the obfervations on the in- 
flammation of the ftomach, will be neceffary to be 
attended to, to prevent a return of this difeafe* 



INFLAMMATION OF THE LIVER. 

It has been affertcd, by very great authorities* 
that the inflammation of the liver, was a dileafe, 
very rarely to be met with ; but diffcclioris fhew, 
that this malady occurs more frequently than has 
been fuppofed, fcirrhous hardnefs, fuppuration, &c. 
being often difcovered in the liver after death, 
when inflammation has not been fufpect.ed. 

Pain in the region of the liver, under the collar 
bone, and in the fhoulder of the right fide, with 
fever, fiiortnefs of breath, a dry cough, vomiting, 
hiccup, and a difficulty in laying on the left fide, 
are the moft confpicuous fymptoms produced by 
an inflammation of this organ. 

In general, the difeafe commences with a rigour, 
or fhivering, which is fucceeded by febrile heat, 
lofs of flrength, thirft, and general uneafinefs. 
The pain is fometimes dull, but at other times very- 
acute. The pulfe is ftronger and quicker than na-. 
tural : the urine high coloured, and fmall in quan- 
tity. 

If 



MEDICAL ADMONITIONS. 2lj 

If this inflammation be properly treated, in the 
firft days of the difeafe, a refolution may, in general 
be obtained. But fhould the difeafe not yield to 
the means which are at firft employed, it is moft 
likely that it will terminate in fuppuration. When 
this takes place, the pulfe becomes fofter, frequent 
ftiiverings pervade the whole fyftern, and the pain 
confiderably abates, and is accompanied by a fenfa- 
tion which is defcribed as refembling that which 
would be produced by a weighty ftabftance added 
to the part affected. The patient becoming heclic, 
lofes his ftrength, and waftes gradually, until colli- 
quative fweats and diarrhsea takes p»lace, when his 
remaining ftrength is fooh exhaufted. The con- 
tents of the abfcefs fometimes obtain a 1 difcharge 5 
either through the biliary du&s, or through fome 
Of the adjoining parts, with which adheiions have 
been formed by the preceding inflammation. In 
fome cafes, where the difeafe has proceeded with 
great rapidity, it has been difeovered, that a gan- 
grene had taken place. This termination is marked 
by a ceffatiori from pain, prOftration of ftrength, 
fmall, and fometimes intermitting pulfe, coldnefs 
of the extremities, and convulftons. 

This difeafe may either poffefs the convex, or 

the concave part of the liver. From the variety 

this may occafion in the fymptoms, fome difficulty 

may occur in afcertaining the nature of the difeafe,* 

D d even 



21 8 MEDICAL ADMONITIONS. 

even to the moft experienced. Nor is this the only 
fource of error in this cafe ; for there are other di£ 
eafes, which, being accompanied by thofe fymptoms, 
which are always obfervable in inflammation of the 
liver, are liable to be confounded with it, by thofe 
who are not thoroughly verfed in the knowledge 
of difeafes. The difeafes here alluded to, are the 
pleurify, colic, and inflammation of the ftomach 
and bowels. 

Thofe who poifefs a fanguine temperament, and 
are of a middle age ; who live freely, indulging in 
the ufe of fpirituous liquors, and are frequently ex- 
pofed to the cold air, are particularly difpofed to 
this difeafe. Violent exercife, expofure of the 
heated body to the cold air, folid concretions, or 
collections of liquid matter in the liver, and drink- 
ing largely of fpirituous liquors, may be the excit- 
ing caufes of this malady. The cure, as in other 
internal inflammations, muft be attempted by the 
timely ufe of bleeding, a ftrict fpare diet, blifters, 
fomentations, cathartic medicines, &c. 

To deliver in a work of this kind a regular pro- 
cefs for the cure of this difeafe, would be to occupy 
the reader's time, without his being likely to derive 
any benefit from it ; fmce, as has been before ob- 
ferved, the utmoft fkill is often requifite to dis- 
cover this difeafe, and diftinguifh it from thofe 

which 



MEDICAL ADMONITIONS. 219 

which are accompanied with fimilar fymptoms. 
This difficulty has been acknowledged by fome, 
whofe knowledge in their profeffion has been fo 
eminent, that their precepts have been held in the 
higheft degree of eftimation by the reft of the med- 
ical world. If fuch men have found a more than 
ordinary exertion of their minds neceffary, in the 
jnveftigation of this difeafe ; furely the informa- 
tion within the reach of a domeftic practitioner, 
can never be fufficient to allow him to undertake 
the cure of fo dangerous a malady. 

Should the difeafe, indeed, appear to be unequiv- 
ocally pointed out by the fymptoms defcribed in 
the foregoing hiftory of the difeafe, and regular 
medical affiftance be not directly obtainable, a large 
quantity of blood, that is to fay, fourteen or fixteen 
ounces, if the patient be an adult, mould be directly 
taken away \ and a mild, but efficacious cathartic, 
be given. Flannels wrung out of warm fermenta- 
tions, may be applied to the region of the liver ; 
after which a large blifter may be applied on the 
pained part, and, the patient being put to bed, a 
fweat may be excited by fuch means, as will not 
caufe any increafe of heat m the fyftem. Warm 
watery drinks, as barley-water, &c. may be ufed 
for this purpofe, taking care, that they are not 
fwallowed in fuch large quantities, as too much 
to diftend the ftomach j fince that will almoft always 
occafion an increafe of the pain. Thofe 



220 MEDICAL ADMONITIONS. 

Thofe who have once fuffered from this difeafe, 
ihould be very careful in not expofmg themfelves 
to cold, moift air, efpecially when heated ; their 
bowels fliould be kept regular, and their diet Ihould 
be compofed of fubftances eafy of digeftion, and 
void of acrimony. Pickles, all kinds of fpiceries, 
and fpirituous liquors, being carefully avoided. 

Thofe who are fo miferable, as to have devoted 
themfelves to the deftrucHve habit of drinking to 
excefs, are particularly liable to difeafes of the liver. 
Tubercles, fcirrhous hardnefs, and chronic inflam- 
mations, are tne changes which, in general, are pro- 
duced in this organ by this pernicious practice. In 
confequence of the fmall degree of fenfibility, with 
which the fubftance of this vifcus is endued, it fre- 
quently happens, that thefe alterations become very 
confiderable, before either pain, inconvenience, or 
any fymptoms arife, from which the patient can 
derive a fufpicion of his calamitous fituation. Too 
often is a man, boafling of the ftrength and invul- 
nerablenefs of his conftitution, which he fuppofes 
repeated exceffes have no way impaired j when fuch 
changes have actually taken place, as prove the 
foundation of diftrefsful and incurable difeafes. 
Several inftances have occurred, where upon dif- 
fection, large tubercles and abcefles have been 
found in the liver, a fufpicion of the exiflence of 
which had never been entertained during the life- 
time of the patient. This 



MEDICAL ADMONITIONS. 22? 

This alarming flatement of the evils refulting 
from the drinking fpirituous liquors, would not 
have been made, but with a faint hope of confirm- 
ing the refolution, of fome one of my readers, who 
may chance to be wavering between the gratifica- 
tion of his perverted tafte, and a wifh to free him- 
felf from a practice productive of fo much evil. 
Unfortunately, it too frequently happens, that, en 
thefe occaiions, fear fuggefts, that the conftitution 
may be already too much injured to allow any 
hope of returning health ; and inclination prompts 
the conclufion, that^to oppofe the appetite will be 
as ufelefs as it will be mortifying. But I muft here 
remark, with the hope of ftrengthening the refolu- 
tion, in a conteft where fo much is at ftake ; that,, 
not only will the animal fyilem fometimes bear 
thefe attacks for a conliderable time, with fo little 
ferious injury, that on their being foreborne it will 
nearly admit of a reftoration ; but that even when 
the conftitution has been fo harraffed by exceffes, 
that a morbid affection of the liver has taken place, 
the return to moderation, and the employment of 
well adapted medical means, will not unfrequently 
ficcafion the renovation of health. 



INFLAMMATION 



J22 MEDICAL ADMONITIONS. 

INFLAMMATION OF THE KIDNEY. 

Pain in the fmall of the back, pafTmg forwards 
toward the bottom of the belly, with fever, vomit- 
ings, and frequent voiding of the urine in fmall 
quantities ; fometimes very pale, and at other times 
of a high red colour ; are the fymptoms which, in 
general, charadterife the inflammation of the kid- 
ney. 

When it is occafioned by the paffage of a calcu- 
lous concretion, that circumftance is fuppofcd to 
be pointed out by a numbnefs of the thigh and leg, 
and a drawing up, or pain of the tefticle of the 
fame fide. 

The termination of inflammation of the kidneys 
may be either in refolution, fuppuration, or gan- 
grene. The firft is known to have taken place, 
from the gradual ceffation of all the fymptoms. 
But when thefe have continued for fome days, 
without remiilion, the pain becoming throbbing 
and more acute, and frequent fhiverings take place, 
it may be known that matter is forming ; which is 
rendered more certain, by the pain afterwards abat- 
ing, and the Ihiverings increafmg. The matter 
thus formed, is, in general, difcharged with the 
urine. It too frequently happens, that after fup- 
puration has taken place, a hectic fucceeds, and the 
patient dies. But when the fymptoms fuffer no 

abatement 



ME0ICAL ADMONITIONS. 22J 

abatement, from the means which are ufed, but the 
vomitings increafe, the pulfe becoming fmaller and 
quicker, the breathing difficult, the extremities 
cold, and the ftools are palled without the patient's 
knowledge ; there is. reafon to fuppofe, that the 
difeafe will terminate fatally by gangrene. 

Exceflive exertions, external injuries, hard rid- 
ing, violent" ftrains, expofure to cold when the body 
is heated, and to a confiderable degree of heat, when 
chilled, may be reckoned as exciting caufes of this 
difeafe. But the moft frequent caufe of this malady 
is, doubtlefsly, calcalous matter impacted in the kid- 
ney itfelf, or in the pelvis of the kidney at the com- 
mencement of the ureter. 

The nature of this difeafe, is not pointed out fo 
clearly by its fymptoms, as to be known by any but 
fuch as have had frequent opportunities of notic- 
ing it. The cure, therefore, ought never to be; 
attempted, by any but thofe who poffefs a requifite 
degree of fkill. 

But where profeffional aid cannot be obtained at 
the firft attack of the difeafe, and the nature of the 
difeafe is rendered evident, a copious difcharge of 
blood may be obtained from the arm ; and ftools 
may be procured, by purgative medicines, and 
emollient clyfters. The external parts, immediately 

over 



224 MEDICAL ADMONITIONS. 

over the pained part, may be fomented with hot 
and {Simulating fomentations ; and if it can be 
obtained, the patient may be immerfed in a warm 
bath, being immediately afterwards put into bed, 
between the blankets, and fupplied freely with 
cooling and demulcent drinks, as barley-water, 
with the addition of gum Arabac ; linfeed-tea, 
decoction of marfhmallows, apple-liquor, &c. with 
the hope of inducing copious perfpiration. A 
flannel, four folded, and wetted with fpirits, to 
which an eighth part of fpirits of hartfliorn is ad- 
ded, may be applied warm to the fmall of the 
back, for the purpofe of exciting heat, and a flight 
degree of inflammation on tne external parts- 
Over this flannel, a bladder filled with -hot water, 
may be applied with great benefit. 

Dr. Buchan fays, " If the bladders be filled with 
" a decoction of mallows and camomile flowers, to 
" which a little faffron is added, and mixed with 
" about a third part of new milk, it will be ftill 
" more beneficial.'* But this opinion is undoubt- 
edly erroneous, fince none of the medical proper- 
ties of thefe ingredients can have any effect, through 
the bladder. Every purpofe will be therefore fully 
anfwered, by the bladder being filled, with hot 
water alone. 

Opiates are ferviceable, in fome cafes, when 
^iven after the inflammation is fomewhat abated, 

but 



MEDICAL ADMONITIONS. 225 

but much judgment is required, to determine 
when they may be employed with fafety ; fince^ 
if ufed at too early a period of the difeafe, the in- 
flammation rnuft necefiarily be thereby inereafed. 
Of this, however, and of the other circumftances, 
in the fubfequent management of the patient, it is 
not neceffary to fpeak, fince thefe will be directed 
by the phyfician. 

But if medical aid fhould have been too long de- 
ferred, or, from the ambiguity of the fymptoms, 
the domeftic practitioner fhould have miftaken the 
cafe, and, of confequence, treated it improperly, a 
fuppuration will molt probably take place. Should 
this happen, and the matter be difcharged with the 
urine, the great eft care muft be taken, by the pa- 
tient, that his food coniift of the mildeft and raoft 
mucilaginous fubftances ; avoiding every thing 
which is heating, or which is fait and acrid : living 
chiefly on milk, puddings, broth, vegetables, fruits, 
butter-milk, &c. Moderate exercife ihould be ufed, 
and that chiefly in the open air. 



INFLAMMATION OF THE BLADDER. 

The inflammation of the bladder is known by an 

acute pain at the bottom of the belly, which is 

much increafed by prefiure, and is accompanied by 

almoft conftant urgings to void the urine and flools. 

Ee Of 



226 MEDICAL ADMONITIONS. 

Of the former, there is fornetimes a total retention, 
at other times it comes away frequently, but in 
fmall quantities at a time, and with much pain : 
the ftools are, in general, obftinately retained like- 
wife, and when difcharged, it is with pain. This 
difeafe is accompanied with fever, in proportion to 
the degree of violence in which it exifts ; but as 
it feldom occurs as a primary difeafe, a coniidera- 
ble variety muft be expected in this, and the other 
accompanying fymptoms. 

The caufes of this difeafe are, calculous concre- 
tions, fuppreflions of urine from obftructions in the 
urethra, cantharides taken internally, or applied to 
the fkin, wounds, bruifes, &c. 

Any admonition as to the admiflion of domeftic 
quackery in this difeafe, feems to be almoft unne- 
ceffary ; as the alarm and the diftrefs it excites is 
generally fufficient, to produce an application to 
thofe beft qualified to adminifter relief. It will be, 
however, proper to call the attention to the ill-con- 
fequences that arife, from delaying, too long, the 
neceffary oppofition to the difeafe. It fornetimes 
happens, that, from the patient's having been un- 
happily too much accuftomed to pain, or from his 
not attributing the diftrefs he experiences to the 
true caufe, he neglects the obtaining of afiiftance 
through the firft ftage of the difeafe. When this 
happens, there is much reafon to fear, that the moft 

Ikilful 



MEDICAL ADMONITIONS. 227 

Ikilful furgeon, or phyfician, will be uriable to pre- 
vent very difagreeable confequerices. Should the 
inflammation poflefs that part which is termed the 
neck of the bladder, or fhould the difeafe be chiefly 
feated in the pro/irate gland which furrounds this 
part, there will be great danger of the patient's 
lofing the power of retaining his urine. 

If, therefore, no doubt remains, as to the nature 
of the difeafe, and regular medical aid cannot be 
foon obtained, blood may be taken away plentifully 
from the arm, ftools procured by fome active puff- 
gative, avoiding thofe of the faline clafs, and clyf- 
ters, of the decoction of poppy-heads, may be in- 
jected every two or three hours. Fomentations, 
alfo, of the fame decoction, may be kept conftantly 
applied, over the bottom of the belly ; and, if pof- 
fible, the patient mould be immerfed in the tepid 
;bath, and in other refpects treated as has been juft 
recommended, in the inflammation of the kidneys j 
excepting that, where an entire retention of urine 
exifts, no more muft be drank than is abfolutely 
neceflary. 

Should the difeafe terminate by fuppuration, the 
conduct of the patient may, in that cafe alfo, be 
regulated, by the directions juft given, in the fup- 
pofed cafe of fuppuration in the kidneys. 

INFLAMMATION 



J28 MEDICAL ADMONITIONS. 

INFLAMMATION OF THE SPLEEN. 

This difeafc, which does not often occur, is to 
be difcovered by fever, with tenfion, heat, fwelling, 
and pain, of the left hypochondrinna, the pain in- 
creafing upon preflure. Inflammation of the fpleen 
requires nothing peculiar in its mode of treatment, 
nor yields any circumftance, from which I can de- 
duce any particularly ufeful obfervation. 



INFLAMMATION OF THE PERITONEUM. 

Inflammation of the peritoneum may be fup- 
pofed to exift, when there is fever, with a confid- 
erable degree of pain of the belly, which is increafed 
during an erect pofture, and no fymptom charac- 
teriflic of inflammation of any particular bowel. 

The treatment of this difeafe, and the manage- 
ment of the patient, fhould be directed by the rules 
laid down, when treating of inflammation of the 
bowels. 

Dr. Baillie, in his moft valuable work, The Mor- 
bid Anatomy, &c. of tlje Human Body, has this 
important remark on this moft ferious difeafe : 
" When the inflammation is flight, I have known 
the pain to be very inconfiderable, and the pulfe to 
be little increafed in its frequency, fo that inflam- 
mation 



MEDICAL ADMONITIONS. 229 

mation of the peritoneum had not been fufpe&ed." 
A difeafe thus infidious muft require all the cir- 
cumspection and knowledge that fludy can fupply, 
even to detect it. To the domeftic practitioner, 
nothing more furely need be faid, to deter him 
from an improper interference, in cafes marked by 
fymptoms, fuch as have been juft defcribed. 



RHEUMATISM. 



Rheumatism may be very properly divided in- 
to two fpecies, the acute and the chronic. Each 
of thefe I mail fpeak of Separately, beginning with 
the acute. * 

The acute rheumatifm generally begins with a 
fenfe of coldnefs pervading the whole body, fre- 
quently arifing to fuch a degree, as to occaiion Shiv- 
ering. This is Succeeded by feverifh heat, the 
pulSe becoming fuller and quicker, and the urine 
higher coloured, than in health. After thefe Symp- 
toms have exifted a day or two, the patient feels 
{harp wandering pains,in various parts oSthe body; 
Sometimes thefe pains accompany the other fymp- 
toms, from their firft appearance, and fometimes 
the pain precedes the febrile fymptoms. The pain 
chiefly affects the joints of the ankles, wrifts, knees, 
and elbows, the patient being, in fome cafes, tor- 
mented with excruciating pains in feveral of thefe 

places. 



230 MEDICAL ADMONITIONS. 

places, at the fame time ; in others, this painful 
affection is produced, in one joint, as it leifens in 
another ; and often diftrefles the unfortunate fuf- 
ferer with repeated attacks of the fame joint. Red- 
nefs and fweliing of the part generally accompany 
the pain. 

The pain, in general, is fo confiderable, as entirely 
to deprive the patient of reft j and the night, in- 
stead of bringing fleep, is generally the time, when 
the pain and reftlefsnefs are moil excemve. Par- 
tial vifcid fweats frequently come on, but without 
any accompanying relief. But fometimes general 
and copious perfpiration occuring, with a diminu- 
tion of the pain, affords great reafon to hope for a 
fpeedy and favourable termination of the difuafe. 

The duration of this difeafe is very uncertain ; 
but, in general, unlefs very efficacious means are 
ufed, it will continue, with very little amendment, 
for two or three weeks, and fometimes even longer. 

This difeafe is much more frequent in cold, than 
in warm, climates ; and in thofe feafons in which 
the weather is variable, than even when it is con- 
stantly cold : thus it is oftener met with in fpring 
and autumn, than in winter. 

Thofe are moft difpofed to acute rheumatifm, 
who are of a middle age, and of a fanguine tem- 
perament. 



MEDICAL ADMONITIONS. 23I 

perament. Thofe, alfo, who have once fufTered 
from this complaint, are more liable to its attacks 
than others. 

Thofe circumftances, which have already been 
fpoken of, as rendering the fyftem apt to take on 
an inflammatory flate, will render the body more 
fufceptible of injury, from the changes in the ftate 
of the atmofphere, and thereby more liable to 
rheum atifm. 

This difeafe requires very great fkill and atten- 
tion in thofe who attempt its cure ; for although 
it is evidently of an inflammatory nature, it is alfo 
very certain, that it is, in many refpects, different 
from that kind of inflammation, of which we have 
hitherto treated ; and that it requires a very con- 
fiderable difference in the mode of cure. 

As in other inflammatory difeafes, fo in this, 
bleeding is often a very powerful remedy : this 
ihould be performed to fuch an extent, as its effects 
may direct, and the ftrength of the patient allow. 
In fome cafes, the taking away of blood may be 
highly injurious ; and in other cafes, where it is 
even advifable, much care muft be taken, left the 
blood be taken away in too large a quantity. Be- 
fides, it muft be obferved, that the difcharge by 
which moft relief is gained, in this difeafe, is that 
of perfpiration. This, if properly obtained, and 

the 



232 MEDICAL ADMONITIONS* 

the patient properly managed, feldom fails of re- 
moving the difeafe ; especially if it has not long 
exifted. During the ufe of fudorifics, the bowels 
fhould be kept regularly open, and the violence of 
pain moderated by anodyne applications to the 
part. 

As it is a point by no means eafy to afcertain 
how far the evacuation of blood may be allowed, 
fo does it require nicety of judgment to determine 
how far evacuations, of any kind, may be permit- 
ted ; fince, it is well known, that there is a period 
in this difeafe, after which, evacuations, of any 
kind, not only weaken the patient, but lengthen 
the difeafe ; and cordial medicines, a reftorative 
diet, and even the ufe of the bark are indicated. . 

In the acute rheumatifm, the regimen muft be 
governed by the fame indications which direct the 
phyfician in his choice of remedies. 

In the chronic rheumatifm, the pains are lefs 

acute, and feldom accompanied with fever ; nor is 

any rednefs difcoverable on the parts affected. The 

larger joints, and the mufcles, are moft commonly 

the feat of this difeafe ; fuch as the hip and moulder 

joints, delloid mufcle, &c. The integuments above 

the pained part are always cold to the touch, it 

being difficult to excite in them either warmth or 

perfpiration. 

Sudden 



MEDICAL ADMONITIONS. 233 

Sudden ftrains and exertions may be mentioned 
here, as a frequent caufe of chronic rheumatifm, in 
addition to what was faid of the caufes, when treat- 
ing of the acute kind* 

The remedies Which may be ufed in this difeafe ? 
are either internal or external. The internal rem- 
edies are chiefly fuch as act by determining the 
blood to the furface, and by producing an increafe 
of perfpiration. Such are, the falts of hartfhorn, 
the volatile tincture of guiacum, &c. the effects of 
which may be accelerated by drinking freely of 
white wine whey, or muftard whey, made by boil- 
ing the feeds of muftard in milk. The external 
applications are chiefly fuch ftimulating applica- 
tions as excite a rednefs in the fkin over the part 
affected : thefe may be, camphorated fpirits, oppo- 
deldoc j or, if thefe prove not fufiiciently ftimu- 
lating, if ufed alone, they may be mixed with the 
volatile fpirits of hartfhorn, oil of amber, &c. Fric- 
tion with a flefh brulh renders thefe remedies ftill 
more effectual. Electricity has been fuccefsfully 
ufed in many cafes. The wearing a plaifter of 
Burgundy pitch over the part has alfo often proved 
ferviceable. 

To prevent the return of either ftate of this di£ 

eafe, the patient fhould defend himfelf by warm, 

but light clothing, from the inclemencies of the 

F f > weather. 



^34 MEDICAL ADMONITIONS. 

. weather. Over the parts which are moft particu* 
larly the feat of the difeafe, fhould be worn flannel, 
or rather clothing of fleecy hofiery. 

The paffing fuddenly out of one atmofphere into 
another, differing much in temperature from the 
former, is very likely to occafion this difeafe. Ex- 
pofure of the body to a ftream of cold air, is alfo 
likely to prove very injurious, efpecially if it be apJ 
plied to one particular part only, and that the body 
is in a heated ftate. Damp clothing mould be care- 
fully avoided, as well as the expofure to a moift 
atmofphere, the ill effects of cold being much in- 
creafed by the joint action of moifture. 



GOUT. 



The paroxyfms of this tormenting difeafe are 
moft commonly preceded, by a general uneafmefs ; 
the feet and legs are affected with numbnefs and 
coldnefs, and frequently alfo with a fenfe of prick- 
ling ; the veins on the furface are alfo faid to be- 
come unufually turgid, and the mufcles of the legs 
to be affected with the cramp. But the circum- 
stances which have been obferved, moft particularly 
to precede the attacks of this difeafe, are the changes 
which, for fome little time before, take place in 
the ftomach ; this organ generally fuffers a confid- 
erable derangement of its functions ; the appetite 

being 



MEDICAL ADMONITIONS, 335 

being much impaired, and the ftomach and bowels 
diftended with wind, the confequence of digeftion 
jiot being properly carried on ; the appetite becom- 
ing, however more eager before the attack. 

According to the obfervations of the attentive 
Sydenham, the paroxyfm generally begins about 
two o'clock in the morning. The patient, having 
gone to bed free from pain, is waked about that 
time with pain poffeffing commonly fome part of 
the foot. Soon after this, comes on a coldnefs and 
fhivering, which terminates in fever. The pain 
increaiing, fometimes refembles that which might 
be expected to be produced by the ftretching and 
tearing of the ligaments, or the gnawing of a dog; 
at others, the parts feem to fuffer the effects of a 
tight ftri&ure, or confiderable preffure, being fo 
feelingly alive, as not only, not to bear the weight 
of the bed-clothes, but not even the heavy tread of 
any one acrofs the room. In this miferable ftate 
the patient continues, toffing about the bed, in vain 
trying the effect of variety of pofture to leflen his 
Sufferings. At about the fame hour of the follow- 
ing morning, the patient, in general, experiences a 
fudden mitigation of the pain, which he com- 
monly attributes to the laft pofition in which the 
limb was placed. Soon after this, a moderate fweat 
coming on, he falls afleep, and, upon waking, finds 
that the pain is confiderably diminished $ but that 

the 



2$6 MEDICAL ADMONITIONS. 

the part \tfhich fufFers is affefted with a red fhining 
fwelling. The pain fometimes continues two or 
three days, increafing at night, and becoming more 
mild towards morning. 

If, after the difeafe has thus completed its courfe 
in one foot, it difappears entirely, the patient re- 
gains the ufe of the foot, and experiences a moft 
.grateful change— ftrength and alacrity having 
taken the places of debility and languor. But it 
often happens, that after the violence of the firft 
attack has fubfided, a fecond will be experienced 
in the other foot. In more inveterate cafes, both 
feet, fometimes, are affected at the fame time ; and 
repeated paroxyfms fometimes extend the fufferings 
of the patient for fix weeks or two months, or 
even longer. 

After the firft attack of this difeafe, the patient 
is, in general, free from it for two or three years j 
but the intervals becoming fhorter between every 
paroxyfm, it often happens, that, at laft, the difeafe 
feldom quits the patient, except for two or three 
months in the fummer. As the ftrength of the 
patient becomes leffened, the paroxifms are accom- 
panied with lefs pain than before ; ficknefs and de- 
bility fhewing, that the caufe of this confifts, not 
in a diminution of the gouty difpofition, but of the 
powers of the fyftem. When the paroxyfms have 
recurred very often, the joints become ftiff,andthe 

limbs 



MEDICAL ADMONITIONS. 237 

limbs enfeebled, and, in many perfons, concretions, 
refembling chalk, form over the joints, and unite 
with the circumftances juft mentioned, in depriv- 
ing the patient of the ufe of the affected limbs. 

The above hiftory contains a defcription of this 
difeafe, in its moft common mode of appearance ; 
or in that form which is chara&erifed as regular 
gout. But it fometimes happens, that inftead of 
the difeafe proceeding in this regular manner, a 
variety of anomalous fymptoms arife, unaccompa- 
nied by thofe affeclions'of the joints, which were 
wont to appear. This ftate of the difeafe is termed 
the Irregular Gout. All the various fymptoms 
which occur in this ftate of the difeafe, cannot well 
be here particuiarifed : thofe which have been moft 
frequently obferved,will, therefore, only be noticed* 

When the head is the feat of the difeafe, giddi- 
nefs, pain, lofs of memory, &c. are the fymptoms 
which occur,and which generally terminate in fome 
fatal affe&ion of the brain. Palfy and apoplexy 
may indeed be, fometimes, the confequence of a 
fudden tranflation of the difeafe to the brain ; and 
may therefore happen, without the occurrence of 
any previous headach, or any other fymptom, from 
which the fatal termination might be fufpected. 

The lungs, as well as the heart, are alfo fubje& 
to ti^fe anomalous attacks ; occasioning fliortnefs 

of 



238 MEDICAL ADMONITIONS. 

of breathing, afthma, palpitations of the heart, 
faintings, and fudden death. 

When the ftomach and bowels are affected by 
this difeafe, a variety of troublefome fymptoms 
arife ; fuch as lofs of appetite, ficknefs, flatulency, 
pains in the ftomach or bowels, acid erucations, &c. 
Frequently at the fame time, the unfortunate fuf- 
ferer experiences the moft diftreffmg dejection of 
ipirits, his mind being poffeffed with groundlefs 
appreheniions and alarms. 

Men are more fubje& to this difeafe than fe- 
males ; and thofe men are more efpecially liable to 
it, who are of a full and corpulent habit. A dif- 
pofition to it feems fometimes to be acquired, and 
at other times loft, by a difference in the mode of 
living. It feldom attacks thofe who live on a fpare 
diet, and who avoid wine and fpirituous liquors ; 
thofe, alfo, who ufe much exercife, are moftly ex* 
cmpt from it. 

Many fuppofe, that the attendance of a medical 
man, is, in this difeafe, entirely unneceffary ; and 
that this muft certainly be one of thofe cafes, 
which may with propriety be committed to the 
care of the domeftic practitioner, whofe knowledge 
refpe&ing this difeafe is not likely, they fuppofe, to 
be much exceeded by that of phyficians themfelves. 

Phyficians, 



MEDICAL ADMONITIONS. 239 

Phyficians, indeed, do not pretend, either to an 
accurate knowledge of the nature of this malady, 
or to the poffeffion of a fpecific, with which they 
are capable of removing it, with fafety: But, in 
confequence of their knowledge of the laws by 
which the animal ceconomy is regulated, and by 
repeatedly obferving the progrefs of this difeafe, 
and the changes produced in it, by the various 
habits and conftitutions in which it occurs, as well 
as the confequences refulting from the various 
means, by which its cure has been attempted ; they 
are often enabled both to palliate the prefent fuf- 
ferings of a patient, and to give hyn fuch direc- 
tions for his management, as may not only leffen 
the frequency, and the duration of future parox- 
yfms ; but may even, fometimes, entirely prevent 
their recurrence ; and, at the fame time, fecure 
the patient from experiencing any ill effects by the 
change thus induced. 

Thefe directions xmift ever be varied according 
to the difference of temperaments ; the morbid 
ffate of the conftitution, which requires to be 
amended ; and thofe errors in the mode of livings 
which may have been the exciting caufe of the di£ 
cafe. Inftru&ions for the condud of patients, in 
every particular cafe of this malady, would of them» 
felves make a volume ; it is not intended, therefore^ 
to attempt more than to offer fome general obfer- 
\ vations. 



240 MEDICAL ADM0N1TI0K3. 

vations, by an attention to which, the ravages of 
this painful diforder may be fometimes leffened. 

The treatment of the patient, during the parox- 
yfm, fhould be directed by the medical attendant ; 
who will be beft able to judge and determine, ac- 
cording to the variety of circumftances, on the 
more proper plan. It may not, however, be amifs, 
to remark here, that the progrefs of the fit fhould 
be interrupted as little as poflible ; but fhould the 
pain become exceffively violent, recoiirfe may be 
had to proper anodynes, the body being at the fame 
time kept gently open, by fome mild laxative. 

The regimen, during the paroxyfm, mould be of 
fuch a kind, as will fupport the ftrength, without 
increafing the heat : broths, puddings, jellies, light 
meats, &c. "are therefore proper. But fpirits or 
wines muft be carefully avoided, as well as fait 
meats, and all highly feafoned food. 

When the fit is entirely gone oft, the patient 
fhould conlider himfelf as entirely free from the 
difeafe, and fhould earneftly fet about preventing its 
return. This may be" done, I am fatisfied, by med- 
icine alone ; but, unlefs a due attention is paid to 
the exercife and regimen, another difeafe, and ge- 
nerally a more fatal one, will be induced. But if 
due attention be paid to the following admonitions, 
there is the greateft reafon to believe, that the pa- 
roxyfm s 



MEDICAL ADMONITlONSo " 24I 

toxyfms may be rendered lefs violent, and lefs fre- 
quent ; and that fometimes their return may be 
even entirely prevented, and that without occa- 
fioning any other difeafe. It is alone by a find 
conformity to regimen, that this difeafe can be 
lafely checked. To obftrucl: the courfe of the dif- 
eafe, and prevent the return of the paroxyfms by 
medicine, whilft exceffes and irregularities are per- 
mitted, is to create a difeafed flate of the fyftem,, 
and at the fame time to hinder nature from infti- 
tutmg that procefs, by which that difeafed ftate 
may be altered. But by carefully avoiding thofe 
injurious indulgencies, the difpofition to the difeafe 
is itfeif removed, and its renewal prevented. 

The victims of this malady are generally thofe 
who have indulged their appetites with eating 
highly feafoned animal food, and drinking freely 
of fermented and fpirituous liquors, particularly of 
wine ; thofe who lead a fedantary life, who are 
diftreffed with anxious thoughts, or whofe minds 
are coniiderably engaged in ftudy. 

The food of thofe who are fubjecl: to this difeafe 
mould be plain and light. At breakfaft they may 
take milk, raw or boiled ; and at dinner, puddings, 
vegetables, and animal food in moderate quanti- 
ties. Their fuppers ihould be fmall in quantity, 
ao'd compofed_ of fuch fubftances as are neither 
G g heating 



242 MEDICAL ADMONITIONS. 

heating nor difficult of digeftion. Pickles fhould 
be entirely refrained from, and acids of every kind 
fhould be ufed with great moderation. Spirituous 
liquors mull never be drank, except in the fmalleft 
quantities, and confiderably diluted. Wines, par- 
ticularly thofe of foreign production, and even malt 
liquors, mull be avoided with equal care. 

Regular exercife is of the utmoft fervice, in mod- 
erating the violence of this difeafe. Such exer- 
cife fhould be preferred, as being joined with amufe* 
ment, ferves at the fame time to exhilarate the 
fpirits ; fuch are rural fports, as hunting, mooting, 
&c. or any mechanical employment, the execution 
of which requires fome little attention of the mind. 

Regularity in the hours of retiring to reft, and 
in rifing, mufl be flriclly adhered to. Late hours 
being exceedingly prejudicial, mud be carefully 
avoided ; as well as too long continuance in bed, 
which, by the debility it induces, is in the higheft 
degree injurious. 

It is a common obfervation, that the affluent are, 
in genera!, the fubjecls of this malady ; it feldom 
happening, that thofe of the inferior clafs of peo-» 
pie are troubled with it, except they have received 
it as their reward for copying the follies and vices 
of their fuperiors in fortune. 

It 



MEDICAL ADMONITIONS. $43 

It is however, by no means recommended, raftily 
to enter on any confiderable change of former nab- 
its, efpecially if a great degree of debility has been 
brought on by former exceffes, or by difeafes. In- 
deed no fuch changes ought to be attempted, with- 
out due advice, after a full confideration of every 
attendant circumftance. 3But ihould it be deemed 
prudent thus to attempt the cure, the patient 
ihould well confider the advantages likely to be 
gained by his felf denial, and firmly refolve to give 
the plan a fair trial, 

The neceffity of a ftricl: attention to regimen, in 
thofe who are fubjec"t. to this difeafe, is fo well and 
fo forcibly inculcated by Dr. Cadogan, that I can- 
not refift the impulfe of recommending theperufal 
of his treatife,to every one afflided with this difeafe. 

Nor can I here refrain from noticing the obfer- 
vations contained in a treatife on the Gout and 
gravel, by Mr. Murray Forbes ; who has moft in- 
genioufly ihewn, by reafonings upon eftablifhed 
chemical facts, and by fair chemical deductions, that 
the gout is a difeafe proceeding from a redund- 
ancy of acid in the fyftem. — "That acids," he 
fays, "are greatly inftrumental towards the pro- 
duction of gout, is an opinion which was founded 
upon obfervation, and has long been maintained. 
This difeafe, as well as gravel, has, in many cafes, 

been 



244 MEDICAL ADMONITIONS. 

been attributed to an exceffive ufe of acids. It lias 
likewife been regarded as intimately connected with 
that {late of the ftomach, in which there is almoft 
a perpetual generation of acid. At the fame time, 
however, a variety of circumftances of a different 
kind have been enumerated as four ces of it. If we 
examine with attention the condition of many in 
whom gout makes its appearance, we ihall gene- 
rally find, that thofe other circumftances have ge- 
nerally been productive of it, when they have ha4 
the previous effect of impairing the digeftive facul- 
ties, and caufing a confequent tendency to the ge- 
neration of acid. Of this nature are infobriety, 
luxury, indolence, and voluptuouinefs. The. dif- 
eafe frequently attends upon a habit of drinking, 
on account of the acids conveyed into the body by 
means of it. The tendency of different liquors to 
produce it, is not fo much in proportion to their 
ilrength, as to the quantity of acid in their com- 
pofition. This afferticn is warranted by the expe- 
rience of ages ; the liquor in which acid predomi* 
nates having been invariably confidered, by the 
bed authorities, as peculiarly predifpoiing to gout. 
Shallow of obfervation muft be the man, who, ac- 
cuftomed to endure the pains of gout, has not be- 
come acquainted with the injury of acids. By im- 
moderate indulgence in intoxicating compounds of 
any kind, by a life of luxury, by a ftate of indo- 
lence, and by an inordinate purfuit of pleafures, 

the 



MEDICAL ADMONITIONS. 245 

the' powers requifite for the procefs of digeftion 
are at laft brought into difbrder, and the contents 
of the ftomach permitted to run into common fer« 
mentation. Thefe, and other circumftances, which 
tend to vitiate the a£tion of the ftomach, and con- 
duce, by reafon of derangement, to the formation 
of acid, may be looked upon as remote caufes of 
' gout and of gravel." 

Dr. WoUaftor., in the Philofophical Tranfaciions 
for the year 1792, has difcovered, by a feries of in- 
genious experiments, that the gouty matter con= 
tains the peculiar (Hthic) acid which Mr. Forbes, 
in the foregoing paffage, fuppofed to be generated 
|n the fyftem, and joined to the mineral alkali. 



SMALL POX, 



The fmall pox appears under two very different 
forms, which are termed the diftincl: and the con- 
fluent. The mode of treatment of thefe being re- 
quired to be as different as are their modes of ap- 
pearance, they will be each treated of feparately. 

The diftincl fmall pox is preceded, for a few 
days, by a fenfe of languor and wearinefs ; and im- 
mediately before the coming on of the febrile ftate, 
frequent cold fhiverings and tranfient glows o£ 
heat are perceived by the patient. The fever, which 
. ■ fucceeds 



24'5 MEDICAL ADMONITIONS, 

fucceeds to this ftate, is accompanied by violent 
pain of the head and loins, and frequently with a 
fevere opprefiive pain at the pit of the ftomach. 
Thefe fymptoms are much increafed on the fecond 
evening of the attack, when the patient generally 
becomes exceedingly reftlefs, and even delirious, 
through fome part of xhe night ; the fkin burning 
with an uncommon degree of heat. 

On the following day, the third day of the fever, 
the eruption is thrown out ; the fkin becoming 
left hot, and being moiftened with a general per. 
fpiratiom 

The eruption which takes place on the face and 
limbs, generally precedes the eruption on the trunk, 
a few hours. 

The eruptions, at their firft appearance, are fmall 
red paints, which, upon being clofely examined, 
and felt by the fingers, will be found to form little 
eminences in the fkin, which are, from their firft 
appearance., feparate and diftinct from each other. 

The puftules gradually affume a conical form, 
and on the fifth or fixth day begin to turn white 
on their tops ; and by the eleventh day become 
entirely white, at which time the puftules acquire 
their greateft magnitude. Their bafes are red and 
inflamed during the whole courfe of the eruption ; 
but when the puftules are entirely filled, they affume 

3 



MEDICAL ADMONITIONS™ 247 

a browrriih hue, their bafes becoming, at the fame 
time, paler. The puftules now mrivel, and an; 
fucceeded by dark coloured crufts. Thefe in a few- 
days fall off, leaving rednefs of the fkin, and fome- 
times a fmall pit in thofe parts which they polTe&d. 

A tenfion of the fkin, fwelling of the face, and 
fome difficulty in fwailowing, generally accompany* 
even the mildefl fort of this diforder, and fome- 
times occafion confiderable inconvenience, where 
the eruption is numerous ; thefe fymptoms being 
generally proportioned to the number of the puf- 
tules. The fever, where the eruption is trifling., 
generally ceafes when that is completed ; but where 
the eruption is confiderable, it continues during 
the pr'ocefs of fuppuration. 

The confluent fmall pox is preceded by a much 
greater degree of fever ; the frequency and fmall- 
nefs of the pulfe fhewing, that the fever is of the 
low kind. The eruption appears alfo more ear!y 9 
is much fmaller, and in greater numbers, the whole 
face often having the appearance of being poifeiTed 
by erifypelatous inflammation. , The fpots affume 
a crimfon colour : they do not rife like the diftinct 
kind, but, remaining flat, and running into one 
another, they very much refemble the mealies, dur- 
ing the firft days of the eruption. As the eruption 
proceeds, little vefieles form on the top of the pim- 
ples* A 



24° MEDICAL ADMONITIONS. 

A fweliing of the face and neck takes place at 
the commencement of the eruption, and becomes 
very considerable ; but fubfides about the tenth or 
eleventh day. In the diftind kind, the inlide of 
the mouth and throat fometimes become fwelled, 
in a flight degree ; but in the confluent kind, this 
affection is generally very confiderable, and is ac- 
companied, in children, with a diarrhae ; and in 
adults, with a copious difcharge of faliva. This is 
frequently fo acrid, as to excoriate the mouth and 
throat ; and, as the difeafe advances, becomes fo 
vifcid,as to be difcharged with the utmoft difficulty. 
The puftules, inftead of being diflended with whit- 
ifh matter, as in the diftinct. kind, feldom rife to 
any height above the Ikin ; and contain only a fe- 
rious fluid, which in the more malignant cafes, is 
commonly of a purple colour. This colour is oc- 
casioned by a mixture with jhe di(folved blood, 
which, in thefe cafes, efcapes at every outlet : from 
this caufe alio arife difcharges of blood, by ftool 
and urine. In this malignant ftate of the difeafe, 
by the fame caufe are produced purple fpots, refem* 
bling flea bites, and bladders of dark coloured or 
limpid feram. Thefe are the appearances diftin- 
guifhed by nurfes by the names of purple and white 
hives. When this fpecies of the difeafe terminates 
favourably, the puflules, filling firft on the face, 
and foon after on the reft of the body, begin to dry 
about the fixteenth day ; the contained fluid then 

exuding 



r HEt)lCAt ADMONITIONS. 249' 

exuding, and forming a dark coloured cruft, which 
remains for feveral days. Ulceration generally 
takes place between them, whence frequently re- 
fults confiderable lofs of fubftance, and difagreea- 

ble cicatrices. 

The fecondaiy fever, as it is" called, which fre- 
quently comes on in this confluent kind, makes its 
appearance, in general, about the period of matura- 
tion j and is commonly accompanied by fymptoms 
of a dangerous nature. 

In thofe cafes where the difeafe terminates fa- 
tally, the fever increafes, the whole furface of the 
body becomes of a pallid hue, the puflules are flac- 
cid, and the {welling of the head fubiides, without 
that of the extremities fucceeding. The patient is 
harrafled with exceffive anxiety and reftlefsnefs, 
which is foon fucceeded by a delirious or a com- 
atofe ftate ; fefpiration* at the fame time, being 
performed with the greateft difficulty. Suffoca- 
tion, or violent convulfions, at iaft puts an end to 
the life and fufferings of the patient. 

The Treatment, In the diftinft kind, where 
the eruptions are very few, and no particular fymp- 
toms appear, little more is required, than to regu- 
late the diet of the patient, and to allow him to re- 
ceive the benefit of free expofure to pure and cool 
air* The diet mould confift of vegetable fubftan- 
H h ces. 



25O MED I CAL ADMONITION S« 

ces, as fago, panada, rice gruel, &c. milk, milk pot- 
tage, rice milk ; and, when the eruption is com- 
pleted, and fuppuration is taking place, a little broth 
and light puddings may be allowed. The drinks 
may be barley-water, toaft and water, and bread 
tea, rendered grateful to the tafte, by the addition 
of currant jelly, or the juice of lemons or oranges. 
Wines and fpirituous liquors, however diluted, 
muft be very carefully avoided ; as well as all kinds 
of heating cardiac medicines, which are too fre- 
quently adminiftered by family dochrefTes, with the 
intention, as they exprefs themfelves, of throwing 
out the diibrder, 

The treatment of the confluent kind requires 
much judgment in the phylician, and even in the 
attendants. It will be unneceffary to treat, in a 
work of this kind, of the variety of medicines 
which will be indicated by the various fymptoms 
Of this dreadful difeafe. Since no one, who does 
not poffefs real medical knowledge, ought to be 
encouraged in attempting the management of a 
malady fo full of danger. 

The exertions, indeed, of the mofl intelligent 
phyfician, will be of little or no avail, unlefs the at- 
tendants are obedient and attentive to his orders. 
In no difeafe whatever, has ignorance and preju- 
dice fuch fway, as in that which is the fubject. of 

the 






MEDICAL ADMONITIONS. 25 1 

the prefent fection. In the firfl ftage of this difeafe, 
it often happens, that the patient is put to bed, un- 
der a load of bed-clothes, in a room heated with a 
large lire, the frefh and pure air being, as much as 

I poflible, excluded : and, left this fhould not prove 
fufficiently efficacious, the febrile ftate of the patient 
is further incrc'afed, by the heating cordials with 
which he is conftantly fupplied. Directed by fimx- 
lar ridiculous prejudices, the patient is not allowed 
a change, either of his body linen or bed clothes 5 
but is obliged to wear, to the end of the difeafe, 
the fame linen, which foon becomes uncomfortable, 
and even offenfive, from the quantity of putrid 
matter it has abforbed. Another injurious prac- 
tice, among practitioners of this defcription, is that 
of allowing their unfortunate patients to remain 
feveral days, without any difcharge from the bow- 
els ; many good women entertaining an idea, that 
the pock would fill better, if the patient could be ' 
prevented from having a ftool, even until the ma- 
turation was complete, or, in their language, until 

- {he pock was turned. 

It is much to be regretted, that thofe who are 
under the neceffity of employing nurfes, do not 
confider that care, and exact fubmiifion to direc- 
tions, are requisites more effential in thefe female 
attendants, than the molt intimate knowledge of 
the various recipes of family quackery, Pofleffing 

this 



%$% ' MEDICAL ADMONITIONS. 

this kind of information, felf-fufEciency and confi. 
dence take fuch ftrong pqfTeulon of them, that, un- 
Jefs they are fuperintended by fome anxious and 
vigilant friend of the patient, their own defultory 
£nd deftrucfcive meafures are fubftituted, for thofe 
which have been dictated by reafon and experience. 

Repeated obfervations have fnewn, that by aug- 
menting the febrile ftate, either by the application 
of external heat, or by the administration of inter- 
nal heating medicines and drinks, the number of 
the puftules may always be increafed. Apprifed 
of this circumftance, the celebrated inoculator Sut- 
ton, ufed to promife, his patient a crop of puftules, 
numerous, or otherwife, according to their wifhes j 
well knowing, that, even in good habits, a trifling 
deviation from the cooling plan he always purfued, 
was almoft fu^-e to be followed by an increafe in 
the number of puftules. How injurious, then> 
muft be that abfurd practice of increafmg the heat 
of the patient, by every means which folly can fug- 
geft, when univerfal experience evinces, that the 
violence of the difeafe keeps pace, with the extent 
tp which this pernicious mode is adopted. 

The advantages arifing from cleaniinefs of the 
perfon of the patient, and every thing around him; 
as well as from frequent ventilation of the bed- 
chamber, muft be fo obvious in every difeafe, dif- 
{inguifhed by fymptoms pointing out a putrefcent 

tendency 



MEDICAL ADMONITIONS. Z$^ 

tendency in the fluids, that to enlarge on them is 
unneceffary ; efpecially as this fubject has been 
already difcuffed, when treating of putrid fever. 

Convulfive fits frequently occur about the time 
of the eruption. The good women who pride 
themfelyes on their medical fkill, always predict a 
favourable termination from the appearance of this 
fymptom y and too frequently accompany their 
prognoflic with advifing the friends of the patient, 
to rely on domeftic aid only, for the cure of a dif. 
eafe, from which they expect no danger. But 
unfortunately the prognoflic is often erroneous, 
and, confequently, the advice improper : for this 
fymptom being' common to both kinds of the dif* 
eafe, is fometimes fucceeded by that ftate of the dif- 
eafe which calls for the utmoft care and fkill ; but 
f nftead of this being obtained, the life of the unfor- 
tunate patient is perhaps entrufted to fome opin- 
ionated and ignorant nurfe. 

An inconteftible proof of the impropriety of per« 
mitting the management of feverifh complaints to 
be entrufted tp family practitioners, is derived from 
confidering, that the utmoft mifchief may be pro* 
duced by injurious interference, at the firfl appear- 
ance of this, or of any of the eruptive fevers. Na» 
ture being difturbed in her procefs, the eruption is 
often either driven out with fuch violence ; or is 
fo improperly retarded, as to occafion the patient's 
fteath, There 



2^4 IDICAL ADMONITIONS. 

There is one circumftance, which, as it may affift 
hi carrying on the above delufion, deferves to be 
pointed out;. The eruption, even when of a very 
bad kind, will often, on the firft days, appear Suf- 
ficiently large and detached, as not to excite alarm, 
in any but thofe who polTefs real fkill and difcern* 
ment. In conference of which, proper affiftance 
Is frequently not called for, until the life of the pa- 
tient is irretrievably forfeited. 

When the eruption makes its appearance in clus- 
ters of a dark red colour, danger is to be appre- 
headed. This is more c&rtainly the cafe, when, as 
the diieafe proceeds, the puftules remain flat, or 
even dented, inftead of becoming full and round, 
and the fkin between the puftules appears pale and 
flaccid. But when purple fpots, like flea bites, ap* 
pear between the puftules ; or when the puftuies 
themfrlves are railed like a blifter, and contain a 
pale or brownifh coloured fluid, the danger is then 
in the higheft degree imminent •, especially if ac- 
companied by bloody urine or ftools. Shiverings 
happening after maturation is performed, and fub- 
fidence of the fwelling of the head, without a tume- 
faction of the hands and feet fucceeding, are alio 
figns of an alarming nature. 

The eyes are liable to fuffer conftderable injury, 
during the progrefs of this difeafe 5 it fometimes 
happening, that total blindnefs is difcovered to be 

the 



MEDICAL ADMONITIONS, *53 

the unhappy lot of the patient, when the eye4:ds 
open, on the fubilding of the fwelling of the face. 

The eyes foon manifeft, in this difeafe, much im* 
patience of the light ; but the fwelling of the eye- 
lids, which take? place, as the difeafe proceeds, ge- 
nerally clofes the eye-lids ; and, by excluding the 
light from the eyes, renders the patient, in this re- 
lpecl, much more comfortable than before. Iri 
children, the relief thus afforded hardly ever efcapes 
obfervation ; and the parents and attendants be» 
come, therefore, lefs folicitous id prevent the adhe- 
fion of their eye-lids from taking place. From 
this omiffion, I very much fufpecl, thefe injuries to 
the eyes frequently proceed. The irritation of that 
membrane which lines the internal part of the eye* 
lids produces a copious fecretion^ refembling matter ^ 
which foon fo clofely agglutinates the edges of the 
"eye-lidsj that very little of this difcharge is allowed 
to efcape. This morbid fecretion is, therefore ? not 
only kept conflantly fuffufed over the eyes, but ? be- 
ing thus detained, is applied to the external menv 
branes of the eye, with fome degree of preffure, by 
which its injurious effe&s 'nmft ijdceiTariiy be aug- 
mented;- 

In thefe cafes, the mode of proceeding is tolera- 
bly clear, though but feldom adopted. The hard- 
ened cruft which unites the edges of the eye-lids,, 
muft be foftened, by laying on it ftrips of lint, or 

of 



2$6 MEDICAL ADMONITIONS. 

of fine folded linen, wetted with warm water * 
when fo much foftened, as to be able to be removed 
with eafe, this mould be done ; and its future ac- 
cumulation muft b£ prevented, by frequently warn- 
ing away the matter, as it exudes, with a piece of 
wet fponge, or lint. By this treatment, the matter 
will be allowed to efcape, as raft as it is fecreted; an 
opportunity may be obtained of afcertaining the 
real ftate of the eyes ; and of employing fuch lo- 
tions, as may be thought neceffary. 

When the fmall pox has entirely completed its 
courfe, yet is the convalefcent, where the difeafe 
has exifted to a coniiderable degree, far from being 
entirely exempt from danger : for frequently the 
habit of body becomes fo changed, and the confti- 
tution is, at the fame time, fo impaired ; that, to 
obtain his perfect recovery, much nicety of manage- 
ment becomes neceffary. It alfo requires great 
{kill and difcernmcnt, to afcertain the nature of the 
difeafed ftate which is induced, and the mode of 
treatment by which it may be removed: 

Dr. Buchan obferves, "As the fecondary fever 
"is, in a great meafure, if not wholly, owing to the 
"abforption of the matter, it would feem highly 
"confonant to reafon, that the puftules, as foon as 
"they come to maturity, fiiould be opened. This 
"is every day practifed in other phlegmons which 
"tend to fuppuration ; and there feems to be no 

caufe 



, itolCAL AttMOmTttSiiSi 2$f 

^caufe why it mould be lefs proper here. On the 
"contrary, we have reafon to believe, that the fe« 
"condary fever might always be leffened, and of- 
"ten wholly prevented." The Doctor farther ob- 
serves,' that "Opening the puftules hot only pre- 
" vents the reforption of matter into the blood, but 
"like wife takes off the tenlion of the fkih, and by 
"that means greatly relieves the patient. It like- 
" wife tends to prevent the pitting, Which is a mat* 
"ter of no fmall importance. Acrid matter, by 
*« lodging long in the puftules, cannot fail to cof- 
"rode the tender fkin ; by which many a handfome 
"face becomes fo deformed, as hardly to bear a re- 
semblance to the human figure." 

Although the Doctor obferves, that, "it is only 
"neceffary when the patient has a great load of 
"fmall pox, or when the matter which they contain 
"is of fo thin and acrid a nature, that there is rea- 
"fon to apprehend bad conferences from its being 
"too quickly reforbed ;*' yet, in eonfequence of 
his'aflerting, that "this operation can never do harm" 
there is great reafon to fear, that the hope Of pre- 
venting deformity, may occafion its too frequent 
adoption by domeftic practitioners, To prevent 
this, I have introduced the opinion of a gentleman 3 
whofe extenfive and fuccefsful practice mult of ne- 
cehlty give weight to his judgement, and render 
his obfervations truly valuable^ He fays— "Allow 
1 1 me 



1|8 MEDICAL ADMONITIONS. 

"me to remark on the practice of thofe, who re- 
"commend the puftules on the face to be opened, 
"when at the height, that the contained matter 
"being thereby evacuated, the face may not retain 
"any difagreeable marks. In a favourable diftinft 
"pock, this caution feems fuperfluous, there being 
"little danger of its leaving any deep impreffion ; 
"and in the confluent malignant kind, when I have 
"feen it pra&ifed, it has always given fuch intoler- 
able fmart, as muft wound any perfon not de- 
prived of humanity itfelf."* 

Parents frequently deceive themfelves, with a 
confidence that their children are exempt from 
danger of infection, becaufe they have been in the 
fame room, or even in the fame bed, with thofe 
who have had the fmall pox upon them. But left 
too great a reliance mould be placed on this cir- 
cumftance, and mould prevent the adoption of ne- 
celTary meafures, it fhould be generally known, 
that children, in early infancy, are not fo liable to 
receive this difeafe, as is commonly imagined ; and 
that a child, who has been expofed to the influence 
of this difeafe, without receiving it, or who has 
even been inoculated without effect, may in a little 
time become highly fufceptible of infection* 

Purging 

* Obfervations on Epidemical Difeafes, &c. by James Sims, 

m;d. 



MEDICAL ADMONITIONS. 259 

Purging is, in general, neceffary after the fmall 
pox j but when the patient has fuffered under the 
confluent kind, great care muft be taken, that the 
dofes are not fo confiderable, nor the intervals be- 
tween them fo fhort, that exceffiye debility be 
thereby produced. 



INOCULATION. 



Inoculation is generally performed by the ap^ 
plication of a fmall quantity of matter, from a 
fmall-pox puftule, to a flight wound in the fkim 

The advantages derived from this practice are fo 
confiderable, as to render it deferving of being con- 
fldered as one of the moft important improvements 
in medicine. By inoculation, the fhocking rava- 
ges of this moft difgulHng and alarming difeafe is 
prevented ; and this, with fo much certainty, that 
it is almoft in the power of man to choofe, whether 
the difeafe ihall appear in its ufual difgufting and 
terrific form j or whether it fhall be produced in 
fuch a degree, as need not to excite the leaft fhock 
or alarm. 

This beneficial practice is now become fo fre- 
quent, and the advantages derived from it are fo 
well known, that the greateft number of the ob- 
jections, which have been raifed againft it, have 

loft 



%6o MEDICAL ADMONITIONS. 

!oft their power ; at lead on the minds of thole 
who give themfelves the trouble to obtain any in- 
formation on this fubject. 

The poflibility of the difeafe being again produ- 
ced, in one who has already had the difeafe by in- 
oculation, is not now fufpected by any, except by 
thofe who obflinately reject the moft pofitive evi- 
dence, and even the dictate* of common fenfe. 

The chief circumftance which prevents the prac- 
tice of inoculation from becoming univerfal, is the 
fufpicion, that as one difeafe may be thus transfer- 
red, other difeafes, which exift in the perfon from 
whom the matter is taken, may, at the fame time, 
be alfo introduced. This fufpicion is the confe- 
rence of having remarked, that it fometimes hap- 
pens, that thofe who have been perfectly free from 
difeafe before, have, immediately after their recov- 
ery from the fmall pox, by inoculation, been af- 
fected with cutaneous diforders, and fcrophulous 
fwellings j and fometimes to fuch a degree, as to 
have disfigured them, or even to have rendered 
them cripples, during the reft of their lives. 

That other dxfeafes may be inoculated, in the 
fame manner as the fmall pox ; and that fcrophu- 
lous affections have made their appearance after im 
oculation, are circumftances which undoubtedly 
may occur. But all this being admitted, ftill it 

muit. 



MEDICAL ADMONITIONS. 26j 

iviuft be denied, that fcrophula is ever inoculated 
with the fmall pox. 

The matter which is contained in the puftule of 
the fmall pox, conflfis of that particular fpecies of 
morbific matter, only, which has been formed by 
thofe difeafed actions, which have been induced by 
the application of the matter of the fmall pox to 
the human body.. This matter, thus fecreted, if 
again applied to the abforbent fyftem, of any one 8 
who has never had this difeafe, or who has not 
been rendered infenfible to its influence, will again 
produce this difeafe, and no other. 

With refpect to fcrophulous tumours, inflamma- 
tion of the joints, abfceffes, &c. which are by fome 
Mppofed to be tile confequcnces of particular hu- 
mours introduce^ into the fyftem, with the variol- 
ous matter j it mull be obferved, that phyficians 
have long known, even before the practice of in- 
oculation was introduced into Europe, that, in 
fome habits, very confiderable changes take place 
after the fmall pox. In fome cafes, difagreeable 
complaints, and thofe even of long continuance 5 
have entirely ceafed, upon the coming on of this 
difeafe j whilft in others, it has been fucceeded by 
various affections of the glands and fkin, to which 
the patient had never before appeared to be fubject* 
Ppth thefe effects fucceed much more frequently to 

the 



262 MEDICAL ADMONITIONS. 

the fmall pox, which takes place in the natural way, 
as it is termed, than to that which is produced by- 
inoculation. It has alfo been obferved to happen 
more commonly when the eruption has been nu- 
merous, than when it has been fcanty. - Whence 
it may be concluded, that thefe circumftances are 
the remit of the changes induced in certain habits, 
merely by the difeafed actions confequent to the 
application of the poifon of the fmall pox to the 
fyftem : and as thefe circumftances generally feem 
to be proportioned to the quantity of eruption in 
the preceding difeafe ; fo the eruption of the inoc- 
ulated being much fewer, than that of the natural 
fmall pox, the probability of thefe changes occur- 
ring, muft be much lefs likely in the former cafe, 
than in the latter. Inoculation,, therefore, fo far 
from being avoided on this account, ought the 
more particularly to be had recourfe to ; fince the 
chance is much greater of obtaining, by it, an ex- 
emption from thefe difagreeable and alarming oc- 
currences. 

The benefits which would refult from the univer- 
fal practice of inoculation, are fo very confiderable ; 
and the eafe with which the operation is performed 
is fuch, that Dr. Buchan, and other benevolent 
phyficians, have recommended to the nurfes and 
parents of children to perform the operation them- 
felves. But were this advice to be followed, I very 

much 



MEDICAL ADMONITIONS. 263 

much fufpect that, from the operation being per- 
formed on improper fubjects ; from the neglect of 
due preparation ; from the want of proper man- 
agement, during the eruptive fever ; from the oc- 
currence of various anomalous fymptoms, which 
do fometimes happen to the moll Ikilful inocula- 
tors, and which would excite confiderable alarm in 
the minds of the ignorant ; that the prejudices 
againft this practice, would be multiplied, and its 
adoption, perhaps, become even lefs general, than 
at prefent. There never would be wanting fome, 
who would be difpofed to place every thing difa- 
greeable, that might happen, to the account of an 
operation, which is feldom performed, without op- 
polition from the prejudices of fome timid friend 
or relation. 

Should the wound made by the incifion inflame^ 
and only fome accidental pimple happen to appear 
on any part of the body .5 the patient, fatisfied of 
having paffed through the difeafe, might neglect 
the neeeffary cautions of avoiding the infection, 
and in confequence of the poifon not having before 
really entered the fyflem, he may now become a 
victim of the difeafe. Such an occurrence would 
doubtlefsly occalion many to adopt the opinion, 
that inoculation does not procure an exemption 
from this difeafe in future. 

Again, 



264 MEDICAL ADMONITIONS. 

Again, it may be obferved, that cafes may hap- 
pen, where the contagious matter may be applied 
in fuch a manner, as to efcape being taken up by 
the abforbents of the part to which it is applied j 
but where, from the patient constantly carrying the 
virus about him, which has been applied for the 
purpefe of inoculation, it may occafion the difeafc 
in the ordinary way. Should this happen, and the 
difeafe terminate fatally, the cafe would be cited 
as an inftance of the fatal confequences of inocula- 
tion. 

For inftance — Dr. Buchan, who ftrongly recom- 
mends to parents to perform this operation them- 
felves, defcribes to them the method he took with 
his own fon. "After giving him two gentle pur- 
ees, I ordered the nurfe to take a bit of thread, 
"which had been previoufly wet with frefh matter 
"from a pock, and to lay it upon his arm, covering 
"it with a piece of flicking plaifter. This remained 
"on until it was rubbed off by accident. At the 
"ufual time the fmall pox made their appearance, 
"and were exceedingly favourable. Surely this," 
"the Doctor adds, "which is all that is generally 
"neceffary, maybe done without any fkill in medi- 
"cine." — But were fuch a mode of practice to be- 
come common, is it not very probable that a cafe 
would fometimes occur, in which, the abforbents 
of the arm not taking up the matter, the patient 

might 



MEDICAL ADMONITIONS* 0.6$ 

might become infected in the natural way, from 
inhaling the poifon he carries about him ? And 
mould the fucceeding difeafe prove fatal, there is 
little doubt but the animadverlions it would occa- 
sion, would not a, little tend to prevent the future 
adoption of inoculation. 

From a laudable zeal to promote the wide ex- 
tenlion of this beneficial practice, Dr. Buchan has 
endeavoured to render the procefs of inoculation 
as fimple and eafy as poffible. But I mould much 
fear, that, from the little ftrefs the Doctor lays on 
the neceffity of preparation, thofe who are inclined 
to become inoeulators may be milled 5 and may 
be induced to place too little reliance on this part 
of the procefs, on being told, "The fuccefs of in- 
" collators does not depend on the preparation of 
"their patients, but on their management of them 
"while under the difeafe.'* I have long been con- 
vinced, that from too little attention to prepara- 
tion, inoculation has produced more considerable 
crops of puftules, than when it was the cuftom to 
attend more rigidly to this circumftanee* 

On this point, the remarks of Mr. Daniel Sutton, 
the celebrated inoculator, are very decided. He 
fays, "I underftand it has been a practice of late, 
to give up preparation, medicinal and dietetic, en- 
tirely, and to rely on the power of medicines, and 
Kk the 



20*6" MEDICAL ADMONITIONS. 

the fkill of the operator, during the eruptive fever*, 
to keep it in due fubjection. But with fubmiflion 
to thofe who choofe to practife in this way, I con- 
ceive that one, at leaft, in eight or ten cafes, may 
give them more trouble than is either defirable or 
prudent. — I never yet could difcover any advan- 
tage from the mere act of inoculation, beyond that 
of afcertaining the time when the patient would 
fall ill." 



CHICKEN OR SWINE POX. 

In the chicken or fwine pox, an eruption, much 
refembling that of a very favourable fmall pox, ap- 
pears after a flight degree of fever. This eruption 
foon proceeds to fuppuration, in which itate it re- 
mains but a little time, before the difeafe termi- 
nates, by the drying up of the puftules, which fel- 
dom leave a cicatrix behind. 

The fimilarity which exifts between this difeafe 
and the fmall pox, not only frequently occadons a 
difagreeable ftate of doubt and fufpence, in the 
minds of the patient and his friends, whether the 
difeafe he has paffed through was the fmall pox or 
not ; but frequently in other inftances, it occafions 
an ill grounded hope, that the patient has paifed 
through the fmall pox, in its milder kind. Hence 
fucceeds a confidence, which may be produ&ive of 

confequences 



MEDICAL ADMONITIONS. 267 

confequences of a ferious nature. The patient, be- 
ing affured of his future exemption from the ef- 
fects of the contagion of this dangerous difeafe, he 
neither avoids thofe Situations in which he knows 
he may be within the fphere of its influence ; nor 
does he have recourfe to inoculation, which would 
either confirm the hopes he entertains, or infure 
his future fecurity, at the moment it convinced 
him of the danger of the Situation, in which he had 
before ftood. 

To prevent, however, an error of this kind, the 
following circumftances may be attended to. ift f 
This difeafe feldom comes on with fo much fever, 
as, 'in general, accompanies a fimilar quantity of 
variolous eruption. 2dly. The eruption, at its 
appearance, generally differs from the fmall pox, ijti 
the pimples being, almoft from the firft, filled with 
a tranfparent liquor ; the velicle being almoft pel- 
lucid. 3dly. The eruption appears more early, 
and paffes through its different ftages more rapidly, 
than that of the fmall pox : the puftules turning 
and becoming dry, fometimes in lefs than half the 
time than what is required in the mildeft kind of 
the fmall pox. An attention to thefe circumftan- 
ces will, in general, point out the difference j but 
when the importance of afcertaining the real nature 
of the difeafe is confidered, there muft be very few 
who would not choofe to have the opinion of thofe 
whofe judgement can be fully relied on. As 



268 MEDICAL ADMONITIONS. 

As to the treatment of this difeafe, medicine is 
very feldom neceffary, it being, in general, fuffi- 
cient, that the patient be kept, if the weather is 
cold, from the open air, and be fupplied with cool- 
ing drinks and light food. 

Sometimes, however, towards the conclufion of 
this difeafe, matter will form under the hardened 
fcabs, occafioning deep and troublefome fores, 
which frequently require, not only the afiiftance of 
the furgeon, but the ufe of internal remedies alfo. 
The choice of thefe muft be directed by the pecu- 
liar habit of the patient, his age, ftrength, &c. 



MEASLES. 



This difeafe depending upon contagion, children 
are moft generally the fufferers from it ; flnee few 
pafs their youth without being expofed to, and af- 
fected by, its influence. 

It moft commonly happens, that, for feveral days 
previous to the coming on of the difeafe, a child, 
who has been expofed to the contagion, will droop, 
lofe its appetite, and become pale and fretful. To 
thefe fucceeds a fhivering, which frequently in 
children, r pafTes without being obferved. This is 
dire£tly followed by fever, accompanied with a 
quick refpiration j lioarfenefs ; frequent, dry and 

rough 



MEDICAL ADMONITIONS* 2.6g 

rough cough ; rednefs of the eyes, fneezings, and 
a conftant watery difcharge from the eyes and nof- 
trils. Commonly on the fourth day of the fever, 
the eruption appears in fmall red points, which 
are generally firft obfervable around the mouth, 
then in the other parts of the face, the ftomach, 
and, at length, on the whole body. The eruption 
feldom riles much above the fkin ; fo that, except 
on the face, little or no prominence is difcoverable. 
After continuing three days, the eruption lofes its 
bright rednefs, and becomes of a brownifh red 5 
and, in a day or two entirely difappears, leaving 
the fkin rough, and as though it had been (lulled 
with meal. The fever generally declining as the 
eruption goes off. 

The consideration of the following circumftance 
will mew how dangerous it is to truft to dom«ftic 
practice, even in fo common and well known a 
tfifeafe. 

Tnis difeafe is very likely, at its firft appearance, 
to be miftaken, by the unexperienced, for the fmall 
pox ; but this miftake is but of little confequence, 
when compared with an error to which family 
practitioners muft be very liable ;— that of miftak* 
ing the eruption peculiar to the putrid fore throat, 
for that of the meafles. This miftake is favoured 
by the mealies itfelf being, fometimes, accompanied 

with 






270 MEDICAL ADMONITfONS. 

with a forenefs of the throat ; whilft in the difeafe, 
which, in diis Hate it refembles, the forenefs of the 
throat does not always particularly call the atten- 
tion, until the eruption has taken place. Such an 
error, if not foon difcovered, can hardly fail to oc- 
canon the death of the patient ; as the mode of 
treatment which fhould be adopted in the one cafe, 
is directly oppofite to that which is required in the 
Other ; plainly evincing the danger of trufting, 
even in fo common a difeafe, to the precarious 
practice of domeftic medicine. 

Treatment. When this difeafe is very flight, 
the fever and cough being moderate, and the 
breathing eafy, and hardly quicker than natural, 
little more is neceffary, than to keep the patient's 
body open, by the afliftance of tamarinds, manna, 
&c. ; at the fame time fupplying him, frequently, 
with cooling mucilaginous drinks, fuch as the pec- 
toral decoction, barley-water, or infufion of linfeed, 
fweetened with honey. His apartment ihould be 
but moderately warm, and great care fhould be 
taken,that he is not expofed to a ftream of cold air. 

To leffen the inconvenience arifing from fre- 
quent coughing, the patient may frequently hold 
in his mouth, a mixture of two parts of oil of al- 
monds, and one of honey ; fwallowing it as flowly 
as poflible. But ftiould this not prove fufficient to 
moderate the cough, it will not be right to tamper 

farther ; 



MEDICAL ADMONITIONS. 2JI 

farther j but immediate medical advice fhould be 
obtained, left ferious mifchief be concealed. 

The circumftance which generally occaftons a 
fatal termination of this malady j and to which, 
therefore, attention mould more particularly be 
excited, is an inflammation of the lungs. This dif- 
eafe, as was more fully demonftrated, when treat- 
ing exprefsly of inflammation of the lungs, often 
comes on £o inlidioufly, as to render it difficult of 
detection, even by the moll Ikilful ; and particu- 
larly in children. When it accompanies the meafles, 
the poffibility of its exifting without the knowledge 
of an ordinary obferver, is very great j and the 
confequence of its continuance, uninterrupted by 
the early ufe of proper means, muft be moil proba- 
bly the death of the patient. 

The likelihood of inflammation of the lungs con- 
tinuing without detection, when accompanying 
the meafles, arifes from this caufe. Quicknefs of 
breathing, the. moft obvious and chara&eriftic 
fymptdm of inflammation of the lungs, is generally 
prefent during the greater part of this difeafe ; and 
•even in thofe cafes where the difeafe terminates in 
the moft favourable manner. Hence it too fre- 
quently happens, that fuch an affection of the 
breathing as calls for immediate recourfe to the 
moft vigorous meafures, is unnoticed, and the op- 
portunity of relief tiered to efcape. To 



2J2 MEDICAL ADMONITIONS. 

To prevent this, the breathing mould be atten- 
tively watched. If it becomes very quick, and is 
performed with a wheezing noife, the fever at the 
fame time being confiderable, and the cough fre- 
quent, and evidently occafioning pain to the pa- 
tient ; every thing is to be feared, and the befl and 
fpeedieft advice mould be obtained. 

A filiation frequently occurs in this, and indeed 
in every other difeafe accompanied by inflamma- 
tion, in which the friends of the patient are very 
liable to be mifled in the opinion they may form, 
of the judgment and abilities of the perfon, under 
whofe care the patient may have been placed. 
This arifes from the difference of treatment em- 
ployed whilft there are hopes of removing inflam- 
mation by refolution, from that which is adopted 
when fuppuration is taking place. In the former 
cafe, the furgeon or phyfieian will in general have 
recourfe to free evacuations, and every other means 
which may have th£ effect of diminifhing the pow- 
ers by which the blood is propelled through the 
fyftem ; but in the latter cafe, it may be neceffary 
to employ a tolerably full diet, cordial medicines, 
and every thing which may prove reftorative and 
invigorating. Suppofe, then, a patient, afflicted 
with any difeafe, dependent on inflammation j in 
whofe cafe the moft proper means have been em- 
ployed for its difperiion, by the medical gentleman 

firft 



MEDICAL ADMONITIONS. 273 

firfi employed, but unfortunately with fuch little 
fuccefs, as to have induced the patient, or his 
friends, to call in fome other perfon, of whofe char- 
acter they may have been led to form an higher 
degree of eftimation. The period in which there 
was a poffibility of removing the inflammation by 
difperfion, being now paft, that mode of treatment 
muft be adopted, which will beft accord with the 
intention of promoting fuppuration. This plan 
being of neceflity opposite, almoft in every refpect, 
to that which has preceded, the comparifon is too 
often made by the ignorant, to the prejudice of the 
perfon who had been firft confulted. "Here/* fay 
they, "was the patient getting daily worfe and 
worfe ; but now, directly that a different mode of 
treatment is adopted, he immediately alters for the 
better. How fortunately we changed our phyli- 
cian ; he certainly has faved him— under the former, 
he as certainly would have loft his life." Thus 
the one is applauded, the other is feverely cenfured 5 
whilft both have entertained the fame opinion ref- 
pe&ing the difeafe, and both have been directed^ 
by exactly the fame principles. 

When purple fpots, and other fymptoms peculiar 
to a diffolved ftate of the blood, accompany this 
difeafe, the greateft judgment and attention are 
required to bring the difeafe to a favourable termi- 
nation. 

L l An 



274 MEDICAL ADMONITIONS. 

An obftinate cough will frequently be found td 
remain, after all the other fymptoms have fubfided, 
In this cafe, it would be extremely wrong to truft 
to the ordinary remedies for coughs, left the cough 
fhould be fymptomatic of more ferious and latent 
mifchief. 

To prevent thefe confeqiiences, frequent purging 
is recommended at the conclufion of the difeafe ; 
and, in molt cafes, muft prove beneficial, being 
likely to diminifh the difpofition to inflammation, 
which is, in general, produced by this difeafe, and 
which occafions the above mentioned effects. But 
dependance is not always to be placed On purging 
alone ; fince, in almoft all thefe Cafes, particular 
attention mould be paid to the regimen, which is 
required to be fpare and cooling ; and, in fome 
cafes, even repeated bleeding may be neceffary. 

I cannot quit this fubject without offering fome 
advice, which, if attended to, cannot but prove be- 
neficial. When one child in a family is attacked 
with this difeafe, let the greateft poffible care be ta- 
ken, left by expofure to a cold and moift atmof- 
phere, ;he remaining children become affected by 
a catarrhal affection j by which the danger of in- 
flammation of the lungs in the fubfequent difeafe 
is increafed. It is obvious, that this advice is 
equally applicable where the difeafe is even known 
to be in the neighbourhood. SCARLET 



MEDICAL ADMONITIONS. . $75 

SCARLET FEVER, 

This fever comes on with cold mivering, pains 
in the head and loins ; foon after, the throat be* 
comes uneafy, and the fwallowing difficult, the in* 
fide of the throat appearing tumid and red. About 
the third day, a fcarlet eruption takes place, mak- 
ing its appearance, at firft, in bright red fpots, on 
the face and neck, and afterwards on the reft of the 
body, and the extremities. From thefe fpots run- 
ning together, the whole fkin becomes of a bright 
fcarlet. Soon after the rednefs appears, white 
fpecks or Houghs are difcernable on the tonfils j 
thefe enlarge, after a few days, fall off, and difcover 
an ulcerated furface underneath ; which, however, 
in general, foon heals. After continuing about 
three or four days, this eruption goes off, the fever 
generally fubfiding at the fame time. 

After this difeafe, the fkin alrnoffc always peels 
off, and frequently in pretty large portions. It 
frequently happens, that an anafarcous fwelling of 
the whole body comes on within a few days after 
the difappearance of the eruption, and is fometimes 
difficult of removal. 

Although, in the above hiftory, I have mentioned 
the forenefs of the throat as one of the fymptoms 
of this difeafe, yet it muft be remarked, that fcar- 
let fever fometimes occurs without any affection of 
the throat. This 



2 y6 MEDICAL ADMONITIONS. 

This difeafe is fometimes to be met with, accom- 
panied with highly inflammatory fymptoms ; and, 
at other times, with fymptoms marking a fimilar 
malignity, with the ulcerated fore throat, or putrid 
fever. 

To attempt to lay down a mode of cure to be 
adopted by family practitioners, in a difeafe which 
varies fo much in its mode of exiftence, as to re- 
quire, at different feafons, and in different fubjecls, 
the ufe of means entirely of an oppofite nature, 
would be highly ccnfurable, fince fatal mifchicf 
might hereby be occafioned. Real benefit may, 
however, be derived from pointing out thofe dif~ 
cafes with which fcarlet fever may be confounded, 
and the confequences that moft probably woul4 
fucceed to fuch a mjftake, 

At the firft appearance of the eruption, it is by 
no means unlikely, that a difficulty may be found, 
by fuch practitioners, in endeavouring to diftin- 
guifh between that which is characteriftic of this 
difeafe, and that which is peculiar to the meafles. 
In thofe cafes of mealies, where the catarrhal fymp- 
toms are very flight, it may very eafilybe miftaken 
for fcarlet fever ; and in fcarlet fever, unaccompa- 
nied by fore throat, efpecially in young fubjeefcs, the 
probability is great that it may be treated as the 
meafles, 

Bu* 



MEDICAL ADMONITIONS. 277 

But the molt to be feared is, left, on the one hand, 
a cafe of fcarlet fever, requiring a cooling treat- 
ment, and, perhaps, even bleeding, be fuppofed to 
be the putrid fore throat, and an attempt for its 
cure be made with heating cordials, wine, &c. ; or, 
on the other hand, that a cafe of putrid fore throat 
be miftaken for fcarlet fever ; and, inftead of the 
free ufe of bark, nourilhment, wine, &c. the con- 
trary mode of treatment be adopted. 

When this difeafe is fucceeded by anafarcous 
fwelling, the great eft care is demanded; fmce,fhould 
it be neglected, an incurable dropfy may be the 

confequence. 



ERYSIPELAS, or ST. ANTHONY'S FIRE. 

Erysipelas, according to the accurate defcrip- 
tion of Dr. Cullen, is an inflammatory affection of 
the lkin, with hardly any evident fwelling ; of a 
mixed, and not very bright red colour, readily dis- 
appearing upon preffure, but quickly returning 
again ; the rednefs of no regular circumfcription, 
but extending unequally ; and continuing, mofl 
conftantly, to fpread upon the neighbouring parts, 
with a pain like to that from burning ; producing 
blifters, fometimes of a fmall, fometimes of a larger 
iize ; always occafioning, as it goes off, a defquam- 
ation of the fcarf ikin, and fometimes f&rminatmg' 
fa gangrene, \thea 



578 MEDICAL ADMONITIONS. 

When it attacks the face, the patient experien* 
ces, firil of all, a cold fhivering, fucceeded by a hot 
ftage, in which there is always more or lefs drowfi- 
nefs, with, fometimes, a confufion of the head, and, 
in fome cafes, even delirium. The affection of the 
(kin appears either on the firft, fecond, or third day 
of the fever ; frequently pciTenmg, by degrees, the 
whole of the face ; fometimes the hairy fcalp, and 
even extending on to the neck. The whole face 
becomes much fwelled, and the eye lids fo much fo 3 
that the patient is oftentimes not a,ble to open them. 

The inflammation continues, in general, about 
eight or nine days, the fever not fuffering any abate* 
ment from the coming on of the affection of the 
fldn. In thofe cafes which have a favourable ter- 
mination, the fever and inflammation, generally, 
about this time, fubfide together. But in other 
cafes, the drowfmefs and delirium increafe, as the 
inflammation proceeds ; and, the external affection 
being communicated to the brain, the patient is 
carried off about the fame period, 

Eryfipelas may be produced by the application 
of heat, or the fudden and partial application of 
cold, efpecially when the body is in an heated ftate. 
External injuries of various kinds, as wounds, 
punctures, and even the flighteft fcratches, are often 
fucceeded by this affection of the furrounding parts. 

* The 



MEDICAL ADMONITIONS. 2J§ 

The application of poifons, more particularly thoft 
of the animal kingdom, often produces this difeafe. 
In fome cafes, it has been fuppoied to be the confe- 
quence of violent paifrons of the mind. 

When eryfipelas exiils only in a trifling degree., 
and without any, or with but little, affection of the 
fyftem, or any other alarming fymptom, there may- 
be no necelEty for calling in profeffional aid ; fince, 
by .an attention to the following advice, the difeafe 
may be, in fuch iiight cafes, carried oft with, the 
utmoft fafety. 

The body mould be kept in a laxative ftate, by 
the ufe of the gentleft aperitive medicines ; care- 
fully avoiding thofe medicines, which, from the 
irregularity with which they act, fometimes pro- 
duce effects far exceeding the intention with which 
they were given. Manna, lenitive electuary, faline 
purgatives, fuch as the Glauber and Rochelle falts, 
imperial drink, tamarind whey, &c. are remedies 
which may be ufed with the utmoft fafety. 

The patient, through the day, need not be con* 
fined to his bed ; it being fnfficient that he avoids 
expofing himfelf to a cold atmofphere* 

At bed time, the patient may take a few grains 
of Dover's fudoriiic powder, or, a very fmall dofe 
of James's powder \ drinking freely of weak wine 

whey. 



2&0 MEDICAL ADMONITIONS. 

whey, or warm barley-water, with a fmall quantity 
of nitre, for the purpofe of procuring a gentle per- 
fpiration. 

Animal food fliould not be indulged in ; pud- 
dings, fago, panada, &c. being the moft proper ar- 
ticles of diet. 

But when erylipelas exifts in a higher degree, or 
is accompanied by a confiderable affection of the 
whole fyftem, or by fuch fymptoms as we are about 
to defcribe ; it not only is of too ferious a nature 
to be entrufted to domeftic medicine, but even re- 
quires the greateft care of the medical or chirurgi- 
cal perfon, whofe attendance is obtained. For the 
difeafe not being uniform in its appearance, and 
the variety depending on widely different ftates of 
the fyftem, as well as of the part affected ; much 
fkill is required, in determining on the mode of 
treatment which ought to be adopted. 

When this difeafe exifts in the face to a confid- 
erable degree, there is great danger of the commu- 
nication of the difeafe to the brain. The affected 
parts fometimes become gangrenous, the change 
often taking place very fuddenly, without being 
fufpected but by thofe, who, by experience, have 
obtained an accurate knowledge of the difeafe j and 
who, by their acquaintance with the laws of the 
animal oeconomy, are enabled to detect the morbid 

ftate 



MEDICAL ADMONITIONS. s8l 

ftate of the fyftem. This difeafe is Very fubjecl: to 
fudden tranllations from one part to another ; fre- 
quently from the external to the internal parts } a 
circumftance which never occurs, without a great 
degree of danger. 

There is one circumftance, which alone ought 
to prevent family practitioners, from attempting 
the treatment of this difeafe, except in the flighteft 
Cafes. It frequently, when properly conducted, 
proving a cure to maladies which have long and 
Obftinately refilled every attempt made for their re- 
moval. When this difeafe attacks with confidera- 
ble violence, the life of the patient may often de- 
pend on timely bleeding. But, of fo much confe- 
quence is the afcertaining the real ftate of the fy£ 
tem, that fhould this evacuation be made improp- 
erly, inftead of faving the life of the patient, a fatal 
termination of the difeafe might be occalioned. 

As the particular ftate of the fyftem is neceflary 
to be afcertained, before it can be determined what 
remedies are moft proper ; fo is it impoffible to give 
here fuch general directions, for the diet and man- 
agement of the patient, as may be applicable in all 
cafes. 

Of the external applications it is not necefiary to 

fay much ; fihce, when the difeafe exifts only in 

M m fuch 



582 MEDICAL ADMONITIONS. 

fuch a degree, as to be a proper object, of domeftic 
medicine, no particular application is neceffary : it 
being fufficient, that it is defended from the air by 
any fubftance, which is not allowed to adhere to 
the part affected. Befides, the felection of external 
applications, as well as of internal remedies, muft 
be directed by the ftate of the fyftem, and of the 
affected part. The following defultory cautions, 
are, therefore, all that can be introduced on this 
fubject. 

Greafy applications almoft always feem to aggra- 
vate the difeafe. Abforbent earths and farinaceous 
fubftances, which are frequently recommended, 
form hard and troublefome crufts, by mixing with 
the liquor which exudes from the part ; the effufed 
fluid, confined by thefe crufts, irritating the parts 
beneath. Cooling and fedative applications, fuch 
as cold water, Goulard's vegito mineral water, &c. 
are very effectual in leffening the inflammation, and 
are, therefore, frequently adopted by domeftic 
practitioners. But it is neceffary to remark, that 
thefe applications, which, at firft, feem to produce 
very pleafant and falutary effects ; do fometimes 
produce, and fuddenly, the molt dangerous confe- 
quences : a gangrene of the part being very likely 
to fucceed to the improper employment of them. 
They fhould never therefore, be ufed in thefe cafes, 
but under the direction of the phyfician or furgeon. 

Eryfipelas 



MEDICAL ADMONITIONS. 283 

Eryfipelas never appears in aged perfons, nor in 
thofe who have lived freely ^without denoting fuch> 
a ftate of the fyftem, as mull demand all the aid 
that can be obtained, from the conjoined powers 
©f experience and judgement. 

Its occurrence in youth and middle age is feldom 
dangerous, except when accompanied with much 
fever, or when it extends over a confiderable fur- 
face. 



ERYSIPELAS OF CHILDREN, 

Very young children fometimes are attacked 
with erysipelatous inflammation, to which it is ne- 
ceffary moil earneftly to call the attention of par- 
ents j fince, from the feeming trifling and infigni- 
ficant appearances which take place on its firft oc- 
currence ? there is too much probability, that it may 
be often allowed to attain a confiderable height, 
before application for affiftance is made. When- 
ever this does happen, the chance of recovery muft 
be very flight indeed ; for even in thofe cafes where 
the utmoft exertions of art are early employed, 
this difeafe frequently carries off the little fufferer 
with great rapidity. 

This difeafe begins in fmall red patches, with 
hardly any elevation, and by no means of fuch an 

appearance^ 



384 MEDICAL ADMONITIONS. 

appearance, as to be likely to excite any alarm ; ex- 
cept in the minds of thofe who are apprifed of the 
infidious and dangerous nature of this difeafe, 
Thefe patches, in fome cafes, make their firft ap- 
pearance on the extremities, and, in others, on the 
lower part of the belly. They extend themfelves 
confiderably over the limbs and trunk, becoming 
hard and more difcoloured, and, if not happily 
flopped by the adoption of the moft appropriate 
xneafures, the difeafe foon terminates fatally. 

To excite the attention of parents, fo that, on 
the firft appearance of this difeafe, they may be ap- 
prifed of the danger which threatens, and be 
thereby induced to apply for immediate affiftance, 
is all that can be attempted here. 



THE MILIARY FEVER. 

The eruption from which this fever derives its 
name, is formed by feveral little bladders, which 
rife on the fkin, of the fize and appearance of grains 
of millet. 

From this eruption having been feen to accom- 
pany various difeafes, it has been much doubted, 
whether it is an original and primary difeafe ; or 
whether it is not merely a fymptomatic diforder, 
proceeding from the difeafe it accompanies. From 

the 



MEE>ICAL ADMONITIONS. 285 

£he circumftance of its having occurred as an epi- 
demic, having attacked many at the fame time, in 
the fame neighbourhood, there is hardly a doubt, 
but that it may exift as a primary djfeafe. But it 
is not neceffary here to enter farther into this 
queftion ; fince the determination would not affect 
the precepts which will be here delivered, refpe&ing 
its treatment. 

This eruption generally makes its appearance 
when profufe fweatings have preceded ; but it has 
fometimes been met with, where no fuch previous 
fweating has taken place. It attacks* both fexes, 
and thofe of every age and conftitution j but child-, 
bed women appear to be moft frequently affected 
by it. 

When it occurs as a primary difeafe, it begins 
with a fhivering, which is foon fucceeded by a con- 
fiderable degree of heat, and pain in the head and 
loins, attended with great anxiety and lownefs of 
fpirits, oppreffion on the breaft, and difficulty of 
breathing. Thefe latter fymptoms, with an itch- 
ing and prickling in the ikin, in general, imme- 
diately precede the eruption, which commonly ap- 
pears between the feventh and fourteenth day of 
the fever ; but it has not been remarked to make 
its appearance on any particular day. The erup- 
tion firfl appears on the neck and cheft, then upon 

the 



286 MEDICAL ADMONITIONS. 

the arms ; and at length is diffufed almoft over the 
whole body, but it is feldom to be difcovered on 
the face. The fkin has fometimes, but very rarely, 
continued dry through the whole of the difeafe ; 
but, in general, the fweating is very profufe. The 
ftools are, for the moft part, loofe, and the urine 
pale, and of a particular lightifh green caft. The 
tongue does not become very foul, and the eyes 
acquire a more than common brightnefs. About 
the time of the eruption, there always arifes a pun- 
gent acid odour, peculiar to this difeafe. In ripen- 
ing, the eruption becomes of a yeilowifh hue ; and 
after continuing a few days, the length of time va- 
rying much in different cafes, it dies off, leaving 
the fkin covered with branny fcales. Sometimes 
the eruption is renewed feveral times in the courfe 
of the fame fever. 

Perfons fweating under febrile difeafes are efpe- 
cially liable to the miliary eruption, and particu- 
larly thofe who have been previoufly weakened by 
large evacuations, particularly of blood. This, 
Dr. Cullen thought, would explain why it happens 
to lying-in women more frequently than to any 
other perfons ; and has remarked it to happen to 
women not in child-bed, but who had been much 
fubject to a frequent and copious menftruation, 
and to an almoft conftant fluor albus. He alfo had 
occafion to obferve it to happen to men in fevers, 
after wounds, from which they had fuffered a great 
lofs of blood. Since 



MEDICAL ADMONITIONS. £$J 

Since the feveral varieties in the mode of treat- 
ing this fever, fhould be the refult of a very nice 
and accurate inveftigation of all the concomitant 
circumftances ; and as this talk requires, in the per- 
fon who undertakes it, a thorough knowledge of 
the laws of the animal ceconomy, and of the chan- 
ges induced by difeafe ; it would be very improper 
to lay down a plan of cure, to be attempted by any- 
one who does not poflefs that necefiary informa- 
tion. 

- The fame reafon that prevents the attempt of 
laying down a regular plan of cure, in a work of 
this nature, is equally forcible againft the endea- 
vour to eftablifh any fixed rules for the regimen 
and management of the patient ; thefe depending 
on the fame circumftances which have been alluded 
to, muft be regulated by the advice of the phyfi- 
cian. 

It may not be amifs to remark here, that this 
eruption fo generally fucceeds profufe fweating, 
that it has been fuppofed to be merely a confe- 
quence of this difcharge. In proportion as the 
fweating is encouraged or checked, fo may the 
eruption be augmented or diminifhed; but the pro- 
priety of either practice cannot be determined, un< 
lefs it is firft afcertained how far the fweating and 
eruption is connected with a critical change in the 
difeafeo 

HEMORRHAGES, 



288 MEDICAL ADMONITIONS, 

HEMORRHAGES. 

Hemorrhage may depend on an increafed ac- 
tion of the blood veffels ; or it may originate in 
fuch a ftate of them, as is oppofite to that vigour. 
It may proceed from too great abundance of blood, 
where there is no error but in quantity ; or it may 
be the confequence of the blood having acquired 
fuch a morbid tenuity, as may enable it to pais 
through openings, by which, in an healthy ftate, 
it would have been detained. 

Thofe who lead fedentary lives, indulging much 
at the fame time, in highly nourifhing and ftimu- 
lating food, can hardly poflible efcape fuch a pre- 
ternatural fulnefs of the fyftem, as is likely to be 
productive of haemorrhage ; fince the evacuations 
not being proportioned to the quantity of nutri- 
tious matter taken in, a due equilibrium cannot be 
preferved, between the quantity of the circulating 
fluids, and the folids which contain them. The 
diminution or fuppreflion of accuftomed evacua- 
tions ; whether of thofe which are natural, or of 
thofe which have been induced by art or previous 
difeafe, will alfo considerably contribute to the for- 
mation of that difeafed ftate of the fyftem, in which 
haemorrhage is likely to occur. In this way much 
injury is often occafioned, by the frequent bleed- 
ings which are fometimes had recourfe to, when 

haemorrhage 



MEDICAL ADMONITIONS. 289' 

haemorrhage has once occurred; and which actually 
promote that ftate of the fyfteni they were in- 
tended to prevent. 

When the abo'v" e deferibed ftate of the fyftem 
has been induced by the foregoing circumftances, 
nothing more is required, than the aftion of on£ 
or- more exciting or occasional caufes, to produce 
the difeafe. The exciting caufes are, whatever al- 
ter the regular circulation of the blood ; as exter- 
nal heat, a confiderable and fudden diminution of 
the weight of the atmofphere, violent exercife, con- 
fiderable efforts of the lungs, certain pafiions of the 
mind, cold externally applied, and fuch poftures of 
the body and applications of ligatures, as may oc- 
tafion a determination, or accumulation of the 
blood in particular parts of the body. 

Dr. Buchan, when treating of this fubjecl, very 
juftly obferves, that " Involuntary fhixes of blood 
may proceed from Very different, and often from 
quite oppofite caufes." Of thefe the Doctor enume- 
rates no lefs than thirteen ; and then very properly 
obferves, that " The cure of a hemorrhage muft 
" be adapted to its caufe." An auertion to which 
all muft readily aiTent, and heartily regret that any 
one fhouid ever be induced to attempt the manage-, 
rhent of a difeafe, dependant oil fuch various cau- 
fes, with no other information than that which 
they may have derived from fome treatife on do- 
meftic medicine. 

N-n If 



29© MEDICAL ADMONITIONS* 

If the fyflem has once Differed a lofs of blood, by 
accident, by art, or by a fpontaneous effufion ; that 
quantity is not only quickly reftored, but frefh 
blood is formed fo faft, that a preternatural fulnefs, 
or plethora, is very foon produced -, which is fre- 
quently fucceeded by a return of the bleeding. This 
is again, in like manner, followed by a rapid refto- 
ration of blood, fulnefs, and haemorrhage. Thefe 
alternations of evacuation and repletion, being thus 
repeated, a difpoiition to haemorrhage is, agreeable 
to a certain law of the animal oeconomy, occafion- 
ed ; and the dileafe, of courfe, rendered more 
difficult of removal. Nor is this all, for, in pro- 
portion to the length of the continuance and fre- 
quency of recurrence of haemorrhage, will be the 
danger of its occafioning other difeafes, either by 
its continuance or fuppreflion. 

The pofitions here advanced, which are founded 
on the known laws of the animal oeconomy, and 
are proved by the daily obfervations of every at- 
tentive medical man ; muft mew clearly the dan- 
ger of permitting, through neglect, or an ill found- 
ed timidity, the continuance of haemorrhage : the 
probability of its inducing future difeafe, having 
been fhewn to be, in proportion to the quantity 
of blood which is permitted to now. 

Every fcience, in an age of enquiry, is conftahtfy 
receiving fome improvement, by the acceffion of 

fomc 



MEDICAL ADMONITIONS. 29! 

Ibme new fad, or fome ingenious obfervation. — 
Thus has the art of healing derived confiderable 
light, from the obfervations and reafoning of Br, 
Cullen, on this point. He having clearly evinced 
the neceiEty of preventing the occurrence of hse* 
morrhage ; and, in moft cafes, of moderating effu- 
iions of blood, when they have actually come on. 

The opinions on which the practice of encourag- 
ing haemorrhage had been founded, were derived 
from fome fallacious conjectures, refpecting the 
influence of the foul on the body ; the foul having 
been fuppofed to direct and occafion fuch changes 
in the fyftem, as were neceifary to the prevention 
or removal of difeafe. It was alfo imagined, that 
the body was, in general, difpofed to a plethoric 
ftate ; that the greater part of the difeafes to which 
the human body is fubject, was produced by this 
caufe ; and that fpontaneous haemorrhage was, al- 
moft always, the confequence of the efforts of cer- 
tain powers in the fyftem, exerted for the removal 
of fome difpofition to difeafe, or of the difeafe itfelf, 
if already formed. On thefe principles the flow 
of blood was permitted, until, through the weak- 
nefs of the patient, it ceafed ; it being fuppofed, 
that when a fufficient quantity of blood had flowed, 
to effect the intended falutary change, it would 
then fpontaneoufly flop. Nor was this the utmoft 
extent of this mifchievous doctrine, for the fame 

arguments, 



5,92 MEDICAL APiMONITlONS. 

arguments, which induced them thus to allow the 
ravages of the difeafe, in the firft inftance, occa- 
sioned them alfo to encourage its return. 

It may be eafily conceived, that thefe repeatecl 
lofles of the blood, on which the formation and 
nourishment of every part of the body depends, 
muft render that fluid thin and impoverished ; 
and occaiion it to pofiefs, after each effufion, lefs 
and lefs of thofe principles, which are more par- 
ticularly appropriated to the fupport of the fyftem j 
although, at the fame time, the circulating fluids 
jnay exceed their natural quantity. 

Thus, then, by permitting the repetitions of 
haemorrhage, may fuch a ftate of the fyftem be 
produced, as will very probably occafion wafting 
the body, dropfy, or fome other difeafe, which, 
being founded on general debility, will be very 
difficult to be removed. 

Dr. Cullen's reafons for -fuppofing that haemorr- 
hage fhould, in general, be avoided, are, " ift. Be- 
" caufe it does not always happen in parts where 
4C it is fafe. sdly. Becaufe often, while it does re- 
ce lieve a plethoric ftate, it may, at the fame time, 
" induce a very dangerous difeafe. 3dly. Becaufe 
" it may often go to excefs, and either endanger 
a life, or induce a dangerous infirmity. And laftly, 
i6 becaufe it has a tendency to increafe the pletho- 
ric 



MEDICAL ADMONITIONS. 293 

*? ric ftate it was meant to relieve ; to occafion its 
" own recurrence ; and thereby to induce a habit, 
* s which, if left to the precarious and unequal ope- 
" ration of nature, may, from the frequent errors 
" of this, be attended with much danger." * 

Having recommended the prevention of plethora, 
rather than the allowing of the return of haemorr- 
hage, it is neceffary to defcribe the means by which, 
this end may be accomplifhed. 

The innumerable fecretions made from the gene- 
ral mafs of blood, occafions a continual expence of 
that fluid; and exercife, as it promotes aimoft 
every fecretion, fo muft it produce an increafe in 
the confumption of the blood. The quantity of 
blood thus expended, is reftored by the continual 
acceffion of new blood, formed from the chyle, 
which is immediately derived from the various 
fubftances taken as aliment. The quantity of blood 
mull, therefore, depend on the quantity of aliment 
from which it is produced, and the degree of ex- 
ercife, by which its expence is occaiioned ; in pro- 
portion as the one or the other of thefc prepon- 
derate, will a difpofition to plethora, or to the 
contrary ftate, take place. 

To prevent the quantity of blood from exceed- 
ing its due proportion, exercife, then, fhould be 

ufed 
Culien'p Firft Lines, vol. is. p. 301. 



294 MEDICAL ADMONITIONS. 

ufed freely, the quantity of food muft be diminifh- 
ed, and mould be compofed of fuch fubftances, as 
are nourifhing, only in a moderate degree ; fuch 
as vegetables, milk, &c. 

Proper means muft, at the fame time, be employ- 
ed, for keeping the bowels in a laxative ftate ; and 
the circmnftances which have been before defcrib- 
ed, as exciting caufes, muft carefully be avoided. 

When haemorrhage has actually come on, and it 
appears proper that it mould be moderated, the 
application of every thing heating and ftimulating 
muft be carefully avoided. The air of the cham- 
ber fhould be cold, and no malt liquor, wine, or 
fpirits, permitted the patient. This caution is 
neceffary, fince it very frequently happens, that the 
patient is very freely fupplied with thefe pernicious 
liquors, with the intention of removing the fick- 
nefs and faintnefs, which accompany the difcharge. 
The patient mould be kept in fuch a pofture, as 
may leaft favor the impetus of the blood towards 
the part from which it flows :-~but this, as well 
as the other means of cure, will be more fully 
treated of, when fpeaking of haemorrhage from 
particular parts. 

Haemorrhages 'proceeding from a dhTolved ftate 
of the blood, will always require the moft vigorous 
exertions for their fuppreflion j fince, by their 

continuance, 



MEDICAL ADMONITIONS. 295 

continuance, they neceffarily increafe that morbid 
ftate on which they depend. 

Upon the whole., when we confider how numer- 
ous the caufes of haemorrhage may be - y and how 
neceffary it is to afcertain the caufe on which each 
cafe depends, before a determination is made on 
io nice a point, as whether the haemorrhage lliall 
be reftrained or mffered to continue ; it muft be 
agreed, that no deciiive ftep ought to be taken, 
until competent advice has been obtained. Until 
then, little more mould be done than removing 
any of the circumftances, which are above enume- 
rated, as likely to become exciting caufes ; and em- 
ploying fuch means, as may moderate the difcharge, 
if it is violent, and the patient apparently linking. 
Skill is required in the treatment of few difeafes 
more than in thofe of this clafs 5 the cafe being 
often fuch, as, from its urgency, to require an im- 
mediate decifion ; and the future health, and even 
the life of the patient, may depend on the judg- 
ment with which it is made. 



BLEEDING FROM THE NOSE. 



From the very confiderable number of blood- 
veffels with which the internal furface of the nof~ 
trils is furniftied, and the delicate texture of their 
covering, we may account for the frequency with, 
which this complaint occurs. This 



2^6 • MEDICAL ADMONITIONS. 

This complaint may be met with at every pei 
of life ; but the changes which take place in the 
fyftem, juft before puberty, and after the age of 
forty and fifty, are fuch as to render it more likely, 
that, at thefe periods, the effufion mould take place 
from this part, than any other. 

During the exiftence of febrile, or inflammatory 
complaints, in which the head is much affe&ed, 
bleeding from the nofe fometimes happens ; in ge- 
neral proving critical, and being followed by the 
removal of the prior difeafe. This difcharge alfo 
often occurs, in fevers which are accompanied by 
a languid Hate of the fyftem, and a diffolved ftate 
of the blood. It alfo frequently happens, when 
there is no reafon to fufpect. it to depend on any 
particular ftate of the fyftem, but is only produced 
by fome incidental caufe ; fuch as a violent effort 
made in fneezing, &c. ; or the application of fome 
hard fubftance to the internal furface of the nofe. 

Bleedings from the nofe in young people are fel- 
dom in any confiderable quantity ; generally ceaf- 
ing fpontaneoufly, after a moderate flow, or yield- 
ing to the application of cold water to the nofe and 
furrounding parts ; or to the application of any 
very cold fubftance, to any part of the furface of, 
the body : as may be obferved, in the common 
practice of putting a cold piece of metal, as a key, 

down 



MEDICAL ADMONITION^ 2pf 

clown the back, next to the fkin, which induces 9. 
Ihivering, foori after which the bleeding generally 
flops. 

Tne infrequericy of this difcharge being directly 
followed by any evident ill coiifequence, and the* 
facility with which it is in generally reftrained, con- 
tribute to miflead the patient and his friends, intci 
an opinion, that ho harm can be produced by a 
difeafe fb common, and apparently fo trivial. The 
patient is therefore, in general, configned to fome 
good woman, the bleeding ceafes, but ho proper 
means are adopted to alter the ftate oh which the 
difeafe depends, and thereby to prevent its return. 

To mew to tho'fe who are tod much difpofed to 
truft to the vague and dangerous practice of do- 
meflic medicine, the hecejlity of obtaining the ad- 
vice of the fkiliul and judicious, in thefe cafes, noth- 
ing more, furely, can be neceffary, than to point 
out the ftate of the fyftem, at this time ; and the 
probable mifchiefs that may fucceed to improper 
management* 

From attentive obfervations, it appears, that in 
thofe young people who are fubjed to bleedings 
from the nofe, there exifts not only a general ful- 
nefs Of blood ; but alfo an increafed determination 
Of the blood towards the head. This is a ftate 
which certainly demands the greatest care and at* 
O o ,, tention £ 



2(}8 MEDICAL ADMOMITIONS. 

tention; fince,ftiould the haemorrhage be retrained, 
without the adoption of due precautions, the blood 
might force an opening through fome other vef- 
fels, fituated, perhaps, in apart, where, as in the 
brain, it might occafion a fatal injury. And, on 
the other hand, if, by neglecl: of proper manage- 
ment, the bleeding mould be fuffered repeatedly to 
return, and become periodical ; there will be rea- 
fon to fear, left, when the patient arrives at his full 
growth, a rupture of a blood-velfel in the lungs, 
terminating in a confumption, may take place. In 
confirmation of this opinion, I may here repeat a 
common obfervation, that thofe, who are moft lia- 
ble to a difcharge of blood from the lungs, have 
been fubjecr., when young, to bleeding at the nofe. 

When this difeafe happens to thofe who are ad- 
vanced in years, the niceft judgement is required, 
in adopting the mode of treatment. As it certainly 
often prevents an attack of palfy, apoplexy, &c. 
there cannot exift a doubt of the impropriety of 
checking the difcharge, at its firft appearance : on 
the contrary, it is frequently neceffary to have re- 
courfe to bleeding, from the arms, and to other 
means calculated to diminifli the general fulnefs, 
and to take off the determination to the head* 

A careful attention to the foregoing indications 
is neceffary, not only at the time when the haemorr- 
hage 



MEDICAL ADMONITIONS. 299 

hage exifts, but mould be affiduoufly perfevered in, 
for a confiderable time after the hemorrhage has 
ceafed ; and, in many of thefe cafes, a ftrid regard 
muft be paid to rules, even cluring the remainder 
of life. 

The general principles, on which it is neceflary 
to proceed in thefe cafes, both with refpeft to the 
treatment of the haemorrhage itfelf, and to prevent- 
ing its return, are laid down in the preceding chap* 
ter. But much caution is neceffary, in the appli? 
cation of thefe principles to particular cafes j £nce 
an error, on either fide, may be followed by con- 
fiderable mifchiefs :'on the one fide, by occasioning 
a rupture of a blood-veffel in f®me vital part ; and, 
on the other, by laying the foundation for dropfy, 
or fome one, of the numerous clafs of difeafes, de- 
pendent on debility. 

Bleeding from the nofe, In febrile or inflamma- 
tory difeafes, efpecially when preceded by pain in 
the head, fluflied countenance, and rednefs of the 
eyes, will, in general, be found to be critical and 
falutary : and, confequently, muft not be checked, 
unlefs it becomes profufe, and is likely to exhauft 
the patient too much, Much caution and fkill is 
requifite, in forming a right judgement, in thefe 
cafes ; iince it often happens, that fevers, and va- 
rious febrile complaints, at their commencement, 
gnd during fome part of their courfe, are accompa- 
nied 



$00 MEDICAL ADMONITIONS. 

nied with ftrong marks of inflammation, to which, 
however, eXceflive debility very foon fucceeds. In 
fuch cafes, this difcharge, although happening at a 
critical period of the difeafe, will, if not very mod- 
(ferate, be likely irretrievably to fink the patient. 

When this haemorrhage happens in putrid fever ? 
Ulcerated fore throat, or any of thofe dileafes, 
which, from their firft appearance, are accompanied 
with great debility of the fyftem, the earlieft efforts, 
muft be exerted to reilrain it ; fince the lofs of even 
a fmall quantity of blood, may, in thefe cafes, be 
productive of fatal confequences. The occurrence 
of haemorrhage, in thefe cafes, is very rarely accom- 
panied with circumftances which render this adv 
vice improper. 

Where there is nothing to forbid the fupprei- 
fion of the haemorrhage, the following means may 
be employed. Cloths dipped in cold water, vin- 
egar, or fpirits, may be frequently applied to the 
nofe and face ; the bocly mould be kept in an erect 
pofture, and expofed to the free accefs of cold air. 
If thefe fhould not prqve fufficient, a piece of lint, 
rolled up in the form of a cone, muft be introdu- 
ced into the noftrils j no benefit can, however, be 
expected from this, unlefs it is applied with fufij- 
cient force to prefs on the orifice of the raptured 
yeljel. If this mould not fucceed, the lint mav, 

previous 



MEDICAL ADMONITIONS. 30I 

jprevious to its introduction into the noftril, be en» 
ireloped in flour j and, if this fail, the lint may 
again be introduced, with the addition to the flour 
of a fourth part of finely powdered allum. It is 
almoft unneceffary to add, that every thing likely 
to ftimulate the noftrils mull be carefully avoided. 

Dr. Buchan recommends, that "the garters may 
pbe tied a little tighter than ufual. Ligatures may 
* 4 be applied to the arms, about the place where they 
f'are ufually made for bleeding, and with nearly 
f'the fame degree of tightnefs. Thefe muft be gra- 
£' dually ilackened, as the blood begins to ftopj and 
f s removed entirely, as foon as, it gives over." 

put this practice is pot likely to produce the be- 
neficial effects, for which it is recommended. Dr. 
Chapman, in his ingenious Thefes on Hemorrhages, 
remarks, that ligatures are fometimes applied to 
comprefs the veins, and thereby to retard the re- 
turn of the blood from any part to the right ven- 
tricle of the heart, with the expectation of dimin- 
ifhing the action of the heart, and of leffening the 
velocity and force, with which the bloocl circulates. 

But this practice, he obferves, was introduced 
before mankind had obtained a thorough know- 
ledge of the circulation of the blood ; and is man- 
sfeftly liable to objections, which cannot eafily be 
overturned. 

In 



302 MEDICAL ADMONITIONS. 

In the firft place, it is difficult to apply the liga- 
ture fo as to comprefs the veins, without making 
a preffure on the arteries alfo ; fo that it may hap- 
pen, that as much injury may be produced, by in- 
terrupting the paiiage of the blood from the heart, 
as benefit can be expected by impeding its return. 
Secondly, fuppofe that the preffure is even confined 
to the veins alone, the beneficial effects which are 
thence expected cannot poffibly laft long ; fince 
fuch a degree of compreffion muft, in a little time, 
affect the arteries, to the fame degree, as though 
the ligatures had been applied to the arteries thenv 
felves. 



H^IMORRHAGY FROM THE LUNGS, 
or SPITTING OF BLOOD. 

FLemorrhagy from the lungs, or, as it is com- 
monly termed, fpitting of blood, is generally pre- 
ceded by a frequent cough, a fenfe of tightnefs, 
weight, and anxiety in the cheft ; and, fometimes, 
by a coldnefs of the limbs, or a general fhivering, 
A faltifh tafte of the fpittle, and a troublefome 
tickling of the upper part of the windpipe, fre- 
quently occur, juft before the difcharge comes on. 
The quantity of blood fpit, at the firft attack of the 
difeafe, differs very much, in different cafes ; fome- 
times only appearing in ftreaks^, mixed with the 

phlegm, 



MEDICAL ADMONITIONS. 30$ 

phlegm, and, in other cafes, proceeding in fuch con- 
fiderable quantities, as even to threaten fuffocation. 

Some judgement is neceffary to diftinguiih, from 
what part the blood proceeds, which is thrown out 
of the mouth ; lince it may not only be derived 
from the lungs, but alfo from the iiomach, the 
mouth, the back part of the noftrils, or the upper 
part of the throat. The treatment which thefe 
latter cafes require, differs fo much from that of 
an haemorrhage from the lungs, that considerable 
injury may be produced by an attempt to perform 
the cure, unlefs the feat of the difeafe is previouily 
afcertained* 

The difcharge fometimes comes on without any 
previous notice ; and is then, generally, the con* 
fequence of fome excellive exertion of the lungs, as 
in a violent fit of coughing, &c. When this is the 
cafe, and the habit of body is perfectly free from 
difeafe, the haemorrhage will fometimes foon ceafe. 
The fame happy termination may, for the moil 
part, be expe&ed, when the difeafe is even the re- 
mit of a plethoric ftate of the fyftem ; but if a dif- 
pofition to confumption previouily exifted in the 
habit, there will be the greateft reafon to exped 
that difeafe may be fpeedily induced. 

But when the difeafe is preceded by the fymp* 
toms before mentioneeL/and the haemorrhage does 

not 



3C4 MEDICAL ADMONITIONS. 

not immediately ceafe, the difeafe will generally' 
proceed in the following manner. After the di£ 
charge of blood has taken place, the foregoing 
fymptoms are, in a great part, relieved ; the cheft 
becomes more free, the breathing is performed 
with lefs difficulty, and the cough is lefs frequent. 
After a little time, more blood oozing from the 
ruptured vefiel, occaiions a degree of weight and 
uneafinefs of the lungs, and the return of the irri* 
tation in the windpipe: to this the cough very foon 
fucceeds, by which the extravafated blood is again 
thrown off the lungs. 

It frequently happens, that the patient is enabled 
to predict the return of the haemorrhage, by the in- 
creafe of fome of the foregoing fymptoms, which 
generally takes place after a little refpite. 

In thofe cafes, where the difeafe terminates fa* 
vourably, the quantity of blood becomes lefs and 
lefs, in every fpit, the breathing remains eafy, and 
the cough foon ceafes. The fpit may remain tinged 
for a little time, but, at laft, refumes its natural ap- 
pearance. 

But if ulceration of the lungs comes on, as the 
fpitting of blood difappears, a fpitting of thick yel- 
low matter comes on ; the breathir.g continues dif- 
ficult, and the cough frequent. When this unhap- 
pily takes place, the wafting of the patient, rrequent 

heat 



MEDICAL ADMONITIONS. 305 

heat in the palms of the hands, and flumings on the 
cheeks, will foon point out too plainly the fatal ten- 
dency of the complaint. 

As this is a difeafe in which there is for the moft 
part a confiderable degree of danger, and as there is no 
cafe in which it occurs, in which the greateft care is 
not neceflary, no one mould think of hazarding in 
any inftance of it, the practice of domeflic quackery. 
In all thofe cafes, however, where the difeafe comes 
onfuddenly, and the aid of the judicious cannot be 
immediately obtained, it will be neceflary to have re~ 
courfe to fuch means as may prevent the return of 
the haemorrhage. With trie hope of accomplifhing 
this, blood mould be taken away from the arm, efpe- 
cially if the pulfe be full, or there exifls any degree of 
fever : the apartment mould be cool, and the patient 
kept entirely ftill 5 particularly avoiding any exertion 
of the lungs, as in loud fpeaking, &c. Animal food, 
and even broths, mull be ftridbly avoided, the diet 
being allowed to confift only of fuch things as contain 
but very little nourimment ; and even thefe, only in 
fmall quantities. Nothing mould be drank warm : 
the beverage which may be barley-water or toaft and 
water, either afcidulated with the juice of lemons, or 
not according to the inclination of the patient, muft 
be taken as cold as pcfiible ; and {tools may be pro- 
cured by the ufe of fome mild purgative, as lenitive 
electuary, manna, &c. By an attention to thefe 
P p rules, 



306 MEDICAL ADMONITIONS. 

rules, and what has been already faid, when treating 
of haemorrhage in general, the difeafe may common- 
ly be prevented from increafing, until proper affifl- 
ance is obtained. 

To prevent the return of this difeafe, the rules 
already laid down, muft be carefully attended to ; 
and to thofe may be added, as particularly requiring 
attention, the injunction, that all exertions be care- 
fully avoided, which detain, or which hurry, the 
blood, in its paffage through the lungs ; fuch as ring- 
ing, loud fpeaking, running, coughing, lifting great 
weights, &c. 



HEMORRHOIDS, OR PILES. 

The piles are fmall round prominent tumors, 
formed near the verge of the anus. When blood is 
difcharged from thefe tumors, they are termed the 
bleeding piles ; when this is not the cafe, they are 
faid to be the blind piles ; and when the difcharge, 
or the unealinefs, proceeds from within the rectum, 
and no tumor appears externally, the difeafe is term- 
ed the inward piles. 

The piles fometimes come on without any previ- 
ous fymptoms ; but, in general, they are preceded 
by fymptoms, which evidently Ihew a plethoric flate 

of 



MEDICAL ADMONITIONS. 307 

of the fyftem ; fuch as giddinefs, pain and weight of 
the head, and pains in the back ; and when the bleeding 
takes place, thefe fymptoms generally go off. The 
quantity of blood varies in different cafes 5 in fome, 
being very trifling, in others fo coniiderable, as even 
to threaten the life of the patient. The difcharge 
frequently, as in other haemorrhages, becomes period- 
ical. In fome cafes, it feems to confift of pure blood $ 
but much difference is. obfervable in this refpecl, 
fince the difcharge is, in other cafes, almoft colour- 
lefs. 

The piles fometimes come on, and continue fome 
time, with but little pain, or inconvenience, except- 
ing heat and itching about the fundament ; but 
fometimes they are from the firft exeedingly painful, 
fwelled and inflamed. In thefe cafes, if the means 
which are had recourfe to do not prove fuccefsful, the 
pain and inflammation increafe, until the whole fyftem 
becoming deranged, fever at length enfues. If the 
inflammation goes on to fuppuration, the patient un- 
dergoes the-utmoft diftrefs, and mofl excruciating 
pain j being often prevented from voiding either ftools 
or urine, until fupuration being completed, a difcharge 
of the contained matter takes place, accompanied by 
an alleviating of almoft all the diftrefling fymptoms. 
In particular habits of body, and in cafes where the 
inflammation has been very confiderable, they fome- 
times 



308 MEDICAL ADMONITIONS.' 

times terminate, not in fuppuration, but in a gangrene, 
or mortification of the effected parts. 

This difeafe moft commonly happens to thofe who 
are beyond the middle flage of life-, and are of a relaxed 
habit of body, and melancholic temperament. Thofe 
who have before fuffered repeated lofTes of blood are, 
for the reafons before affigned, particularly liable to 
attacks of this difeafe ; and, for the fame reafons, 
thofe who have been long fubject to other difcharges, 
fuch as from ulcers, iffues, &c. are frequently troubled 
with this complaint, upon thofe difcharges cealing. 
Want of exercife, and exceflive indulgence in eating and 
drinking, particularly of highly feafoned foods, wines, 
and fpirituous liquors, are frequent caufes of this 
malady. But the moft frequent exciting caufe of 
this difeafe, is the patting of indurated excrement, or 
the too free ufe of ftrong purging medicines, as aloes, 
jallap. &c, But whatever circumftances occafion a 
fulnefs of habit, and diminithes the freedom of the 
circulation in the inteftines, and in the inferior part of 
the body, may produce this difeafe. 

In thofe cafes where but little pain or inconveni- 
ence is produced, no applications will be neceffary to 
the part, nor any internal medicine required, except- 
ing fome gentle laxative to be taken occasionally. 
The fymptoms, however flight, mould ferve to ad- 
monilh the patient of the neceffity of his adopting 

, the 



MEDICAL ADMONITIONS. 309 

the proper regulations in his diet, and mode of living 5 
left the difeafe be augmented, or fome more danger- 
ous malady be induced. This is a moment which 
ought not heedlefsly to be pafled over, fince the difc 
eafe being once permitted fully to form itfelf, a difpo-? 
fition to future returns, fucceeds 5 and this difpofition 
is increafed by each frefh attack. On the other hand 3 
fhould the progrefs of the fymptoms be checked, and 
the haemorrhage flopped, without due precautions, a 
foundation may be laid for fome more alarming ancj 
dangerous difeafe. 

Since there cannot exift a doubt, but that very 
confiderable mifchief is often the confequence of pa- 
tients themfelves, and of domeftic practitioners adopt- 
ing the opinion, that the hemorrhoidal dicharge is 
not only innocent, but falutary, and even neceffary ; 
it cannot but be beneficial to endeavour to {hew how 
far this opinion is correct, 

A plethoric ftate of the fyftem, in general, accomr 
panies the firft, as well as every fubfequent attack of 
the piles. If this is not otherwife reduced, a bleeding 
from the piles takes place, and the equilibrium is 
thereby reflored. But if the caufes of this morbid 
ftate of the fyftem are not removed, the fulnefs re- 
turns ; the parts affected with the piles having been 
weakened by the previous distention, more readily ber 
come again loaded with blood, and the hemorrhage 
} 1 again 



310 MEDICAL ADMONITIONS. 

again takes place. Thus, fucceflive alternations of 
fulnefs and hemorrhage are produced, until, at laft, 
the returns of plethora become periodical, and even, 
in fome meafure habitual. When this is the cafe, if 
the hemorrhage be prevented, without, the neceflary 
regulations being adopted, other difeafes, the confe- 
quence of plethora, may be induced ; and may be 
removed by the return of the hemorrhage. But 
here let it be remarked, that thefe difeafes are attri- 
butable to the permitting of the hemorrhoidal 
flux, at the firft, inflead of correcting thofe diforders 
of the fyftem by which it was occafioned. 

When the piles are accompanied with much pain, 
it is to be feared that fuppuration may take place. 
Many applications are recommended for the piles, 
when they are become fwelled and painful ; but to 
be able to point out which of thefe is preferable, it is 
neceflary fir ft to know the actual ftate of the parts, as 
the remedies which may be proper where inflammation 
has not taken place, may prove highly injurious where 
that ftate of the parts exifts. Inftead of enumerating 
thefe, I ftiall, therefore, call the attention to the confe- 
quences of neglecting to employ the moft proper 
means in fuch a cafe. 

In moft cafes of painful piles, more or lefs of inflam- 
mation is prefent. And if this inflammation is not fuc- 
cefsfully oppofed, it will foon extend itfelf to the ad- 
joining 



MEDICAL ADMONITIONS. 31I 

joining parts, not only producing the moft excruciat- 
ing pains in the fundament, but alfo in the neck of 
the bladder ; occasioning almoft an entire fuppreffion 
of the urine. When this happens, the patient may be 
allured, that it will be with very great difficulty that 
a fuppuration in the adjoining parts will be prevent- 
ed. Should fuppuration take place, the patient 
ihould confider, that he has now a much more dis- 
agreeable difeafe to combat with, than before, and that 
the free and fkilful exercife of the chirurgic art, alone 
can prevent him from fuffering the inconvenience and 
pain of a fiftula. • 

Where the inflammation is violent, and continues 
for fome time, without any appearance of fuppuration, 
an event may be reafonably feared, by which the life 
of the patient mull neceiTarily be brought into the 
moft imminent danger. Hence it muft plainly ap- 
pear, that where the piles become inflamed, the moft 
judicious exertions are neceffary, to prevent the moft 
ferious evils from taking place. 

The regulations of diet, exercife, &c. neceffary 
for the prevention or removal of that ftate on which 
this difeafe depends, may be learned from what has 
been already laid down in the immediately preceding 
chapters. 

IMMODERATE 



'£12 MEDICAL ADMONITIONS. 

IMMODERATE FLOW OF THE MENSES. 



It is not every variation in the period or quan- 
tity of this difcharge that is to be conlidered as a dif- 
eafe, fince every healthy female is not exactly alike 
in thefe refpe&s ; the difcharge recurring, in forne 
cafes at longer, and in others at fhorter, periods ; in 
Come cafes in larger, and in others in fmaller quanti- 
ties ; without the appearance of any circumftance 
that points out the variation to be unnatural, or un- 
equal to the neceffities of the conftitution. Slight 
deviations in thefe refpecls may alfo occur in the 
fame perfon, without being accompanied by any 
mark of difeafe. 

But when the difcharge is considerably increafed 
beyond its accufhomed quantity -, when its returns 
are at much fhorter periods than ufual ; efpecially if 
preceded or accompanied by cold chills, fucceeded by 
heat and thirft, pain in the head and giddinefs, fhort- 
nefs of breath, and pain in the loins, it may be conclu- 
ded, that it exceeds the natural and falutary quanti- 
ty. If the difeafe is not now checked, other fymp- 
toms, the confequence of exceflive debility, foon 
come on ; the face becomes pale, the feet are with dif- 
ficulty kept warm, and become affected with an cede- 
matous fwelling ; a fluttering and extreme finking is 
felt in the infide 5 the flomach, inftead of requiring 

food 3 



MEDICAL ADMONITIONS. 313 

food, is almoft conftantly afFe&ed with naufea ; the 
pulfe is fmall and frequent ; the furface cf the body is 
frequently covered with a cold fweat, and extreme ag- 
itation or fainting is occafioned, even by the flighieft 
alarm. When the difeafe has proceeded thus far, a 
trifling circum fiance may produce an alarming 
change ; a fudden and copious difcharge may be al- 
moft immediately fucceeded by fainting, and even 
death ; or the continuance of a difcharge, not fufn- 
cient to occafion immediate difiblution, may be pro- 
ductive of dropfy, and other complaints founded on 
extreme debility. 

The increafe, both in the frequency and the quan- 
tity of the difcharge, may take place fo gradually, and 
the mifchievous confequences be induced in fo in- 
ildious a manner, that frequently the patient may be 
reduced to a dangerous ftate of debility, before (he is 
fufficiently alarmed to feek for affiftance ; or even 
before fhe is convinced of the exiftence of any dif- 
eafe. 

Females who lead a life of indulgence and inactiv- 
ity, and who have been Weakened by frequent mif- 
carriages, difficult labours, and* immoderate difchar- 
ges from other caufes, are particularly liable to this 
complaint ; as well as thofe who have fuffered the 
fuppreffion of fomelong continued evacuation, or who 
have fubmitted to frequent bleedings, Diftrefs, and 
Q^q anxiety 



314 - MEDICAL ADMONITIONS. 

anxiety of mind, indulgence in wine, and fpirituous 
liquors, alio difpofe to this complaint. The exciting 
caufes of this difeafe, may be the fame with thofe al- 
ready enumerated, when treating of the other hae- 
morrhages ; to which may be added, as particularly 
likely to induce this fpecies of haemorrhage, fudden 
frights, violent fits of paflion, and the improper ufe of 
flrong cathartic and forcing medicines ■; particularly 
of the various pills, advertifed under different titles, 
but which are almoft wholly compofed of aloes, fcam- 
mony, and other violent draftic purgatives ; which 
have the power alfo of determining the blood into the 
uterine veffels. 

This haemorrhage is not always an original com- 
plaint, it fometimes being a fymptom of fome other 
difeafe. Ulcers, polypous concretions, fcirrhous and 
cancerous affections of the womb, being frequently 
accompanied with this fpecies of haemorrhage* 

When the various modes in which this difeafe 
makes its attacks are confidered ; being one while fo 
violent, as to excite well founded fears of immediate 
difTolution j at others, fo infidious as entirely to fap 
the flrength of the conflitution, and bring on difeafes 
the mofl difficult of cure, before the lead alarm is en- 
tertained by the unfufpecting patient 5 the neceffity 
of procuring early help muft be obvious to every one. 
And when the variety of caufes by which it may be 

produced 



MEDICAL ADMONITIONS, » 315 

produced is alfo confidered, not a doubt can be enter- 
tained of the imprudence and danger of truiling the 
cure of fuch a difeafe, to the hazardous attempts of 
domeftic quackery ; efpecially, fince the hemorrhage 
may, as has been juft obferved, be only the fymptom 
of fome other difeafe, which maybe entirely overlook- 
ed and neglected -, whilfl the endeavours made for 
the removal of the haemorrhage muft neceffarily prove 
ineffectual, the difeaie on which it depends continuing 
unabated. 

If an additional argument is neceffary to prove 
the danger of fuch interference, it may be derived 
from the confederation, that the neceffity of making 
that difficult and nice diflinction between hcemorr- 
hagy depending on increafed vigour, and that which 
arifes from the contrary date of the fyfters, is more fre- 
quently required in this than in any other fpecies of 
haemorrhage. And as the difeafe may depend on either 
of thefe two oppofite ftates of the fyflem, endeavours 
for a cure which are made without neceffary ikill, 
may not only prove ineffectual , but, by promoting 
that ftate of the fyflem on which the difeafe depends, 
may increafe every fymptom. 

Directions for the management of this difcharge, 
when it is not confiderable, as well as for preventing 
its return, are here unneceffary ; fince, in thefe cafes, 
there is no preffure of hafte which ought to prevent 

application. 



£l6 MEDICAL ADMONITIONS. 

application, for the advice of the regular profeiibr of 
the healing art. When the haemorrhage is fudden and 
profufe, the patient fhould, as foon as poflible, be de- 
prived of every part of her clothing, which may occa- 
sion the leaft interruption to the free circulation of the 
blood, and be placed in an incumbent pofture, in a 
cool chamber, being covered but lightly with bed- 
clothes. Every thing which is drank mould be as 
cold as poflible, and cloths dipped in cold water fhould 
be frequently applied to the loins and neighbouring 
parts. 



VOMITING OF BLOOD. 

When blood is brought up manifeftly by vomit- 
ing, there can be no doubt of its proceeding from the 
flomach. An uneafy flate of the flomach commonly, 
for fome time, precedes this difcharge. Pain in the 
region of the flomach, accompanied by anxiety, and 
a fenfc of oppreffion, is in general experienced, jufl 
before the coming on of the haemorrhage. 

If this complaint is the confequence of a fuppreffion 
of the menflrual, or hemorrhoidal difcharge, and is in 
a (mail quantity, there may not be reafon to appre- 
hend much danger. But if the difcharge is very con- 
siderable, and black grumous blood is difcharged, both 
by vomiting and by floolj the difeafe is really alarm- 
ing, 



MEDICAL ADMONITIONS. 317 

ing, and demands a careful enquiry as to its caufe, and 
the raoft fkilful exertions to effect its cure. Not a 
moment mould be loft, but the beft affiftance mould 
be obtained as foon as poflible. In the mean while, 
the means recommended in haemorrhage from the 
lungs, may be employed. Thofe who have fuffered 
from this diforder, mould, for fome time afterwards, 
be very careful to take nothing into the ftomach 
which may be likely to irritate it, or to produce vom- 
iting. The mode of living Ihould, for fome time 
afterwards, be fimilar with that recommended after 
inflammation of the ftomach. 



VOIDING OF BLOOD FROM THE 
. URINARY PASSAGE. 

Blood difcharged. with the urine may proceed from 
the kidneys, the ureters, the bladder, or the urethra 
(the canal which conveys the urine from the bladder.) 
The part whence the difcharge of the blood proceeds 
is to be difcovered by attending to the fymptoms 
which preceded, and which accompany the difcharge. 
In general, it is a fymptomatic affection of fome dif- 
eafe, and by the cure of that only can be removed. 

CATARRH. 



*lS MEDICAL ADMONITIONS. 

CATARRH. 



At the commencement of this difeafe, the patient 
generally complains of wearinefs, and diiinclination to 
move j frequent thrills of cold, fucceeded by tranfient 
gleams of heat, run through the whole frame ; the 
head aches, and feems heavy, and the throat feels 
rough and dry. Soon after this, a flight difficulty of 
breathing, hoarfenefs, and frequent dry cough, fuper- 
venes. Oftentimes the difeafe is accompanied with a 
heat and forenefs of the eyes and noftrils ; a limpid, 
acrid liquid flowing conflantly, both from the nofe 
and eyes. 

As the difeafe proceeds, the Ikin becomes hot and 
dry, the pulfe hard and full, and the urine high colour- 
ed ; the patient foon lofes all defire for animal food, 
is reftlefs and thirfty, and much harrafTed with the 
cough. After a little time, a fmall difcharge of mucus 
is produced by the cough, which gradually increafes : 
the roughnefs and forenefs of the throat, the fever, 
cough, and other fymptoms, leflening, as this dif- 
charge thickens j foon after which, the difeafe, gene^ 
rally, goes entirely off. 

The progrefs of the difeafe, as here defcribed, is, 
however, only to be met with in thofe cafes where 
feature has been affifted by well adapted means - 3 or, 

at 



medical Admonitions. 319 

at leaft, has not been interrupted by improper inter- 
ference. But where the difeafe, exifting to a con- 
fiderable degree, has been neglected -, or where trifling 
cafes have been exafperated by improper treatment ; 
a variety of fymptoms may arife, by which the real 
nature of the difeafe may be concealed from an unin- 
formed practitioner, and the danger, of neceffity, 
augmented. 

Thofe who have already fuffered from this difeafe^ 
are particularly liable to future attacks ; thofe alfo, 
whom previous indifpofitions have rendered it necef- 
fary to confine themfelves to the houfe, for a time, are 
very likely to be affected with this difeafe, at their flrfb 
expofure to the open air. 

This difeafe is fometimes produced by a fpecific 
contagion ; and when it thus occurs, it is obferved ta 
fpread to a much greater extent than any other epi- 
demical difeafe. But the moft frequent caufe of this 
malady is the too fudden tranfition from one atmof- 
phere to another, much higher or lower in its degree 
of temperature. 

When a perfon is affected with what he fuppofes to 
be a common cold, as it is termed, he generally either 
neglects it entirely, or attempts its removal by fpiritu- 
ous and heating drinks, hoping thereby to excite a 
fweat In the one cafe, the parts affected become Co 

jniured 



3 20 MEDICAL ADMONITIONS. 

injured and weakened, by the long continuance of the 
difeafc, as to be rendered particularly liable to future 
attacks ; in the other cafe, there is the greateft pro- 
bability that the difeafe will be immediately aggravat- 
ed, and perhaps additional diforders occafioned. 

Where the nature of the difeafe is obvious, and 
where the breathing is perfectly free, the feverifhnefs 
very flight, the appetite but little impaired, and the 
cough not very frequent, attempts may be made, by 
domeflic treatment, to carry off the difeafe at its com- 
mencement. This may frequently be done, by 
bathing the feet and legs in lukewarm water, immedi-, 
ately before going into bed, and drinking freely of 
fome warm diluting liquor, fuch as barley-water, 
weak whey, &x. thereby exciting a free perfpiration. 

The patient fhould carefully avoid every circum- 
ftance which may tend to quicken the circulation of 
the blood. Animal food, fpirituous liquors, wine, 
beer, &c. mould be entirely omitted. The food 
ihould only confifc of milk and vegetables, and their 
various preparations, fuch as rice-gruel, panada, falop, 
fago, &c. The drinks may be barley-water, pectoral 
decoction, infufion of linfeed, bran-tea, 8cc. Thefe 
may be fvveetened with honey, and rendered plealantly 
acid by the addition of the juice of lemons or oranges. 

In thofe cafes where the cough is very frequent, 
the fever confiderable, and the breathing interrupted 

by 



MEDICAL ADMONITIONS. 321 

by tranfient pains, or tighfnefs of the cheft, the 
management of the difeafe will require the uttnoft 
care and fkill : fince, if a proper mode of treatment 
is not early adopted, inflammation of the lungs will, 
very probably, foon fucceed, which, if not fpeedily 
detected and removed, will be too likely to terminate 
in a decline. 

In thofe perfons who have previoufly fufFered from 
fpitting of blood, or who have been at all difpofed to 
confumption, it is abfolutely neceflary that the mod 
cautious and vigorous meafures be purfued, at the 
very onfet of the difeafe ; as there exifts not a doubt, 
but that, in fuch fubjedts, a common flight cold, as it 
is termed, frequently proves the exciting caufe of a 
confumption. 

The probability of confumption immediately fuc- 
ceeding to inflammation of the lungs, muft be readily 
conceived by any one, who has even the flighteft 
knowledge of the functions of that organ. To fuch, 
then, it muft be fufficient to give them the informa- 
tion, that this difeafe, the danger of which is fo flightly 
eftimated, is an inflammatory affection of the mucous 
membrane which lines the windpipe, and even its 
ramifications in the lungs. If this be duly confidered, 
furely the probability of the inflammation extending 
itfelf to the fubftance of the lungs muft appear fuffl- 
ciently evident, as well as the neceflity of early adopt- 
Rr ing 



322 MEDICAL ADMONITIONS. 

ing the moft powerful means for the removal of the 

difeafe. 

Nor is it to the firft attacks of this diforder only, to 
which I would call particular attention. Many cafes 
may occur, in which the firft fymptoms of the difeafe 
may be very flight ; and the difeafe may proceed 
without being characterifed by any marks, which may 
lead to a fufpicion of danger j but in which the 
cough may be tedioufly protracted! Frequently, when 
this is the cafe, the patient and his friends, deceived 
by the abfence of fever, and the fmall inconvenience 
otherways experienced, allow the continuance of this 
injurious fymptom, until fuch mifchief is produced, 
as no fubfequent care, or exertion, can remove. 

From inattention and improper management, at 
the commencement of this difeafe, originates that af- 
fection of the lungs, which has been defcribed as 
baftard peripneumony ; true inflammation of the 
lungs, and confumption, alfo frequently proceed from 
the fame caule. From its frequent recurrence pro- 
ceed conftant and troublefome accumulation of mucus, 
or phlegm, and aflhma. 

The frequency with which this difeafe occurs, in 
this part of the world, and the flight degree of intereft 
and alarm, which is, in general, excited by the ex- 
prefiion, catching cold by which thU difeafe is com- 
monly 



\ 



MEDICAL ADMONITIONS. 323 

monly defcribed, to frequently occafion that neglect, 
by which the foregoing maladies are produced. 

Fully fatisfied that vaft numbers fall victims to the 
fuppofed infignificance of this infidious enemy, I have 
been anxious to difplay to your view the danger of 
not oppofing his attacks, however weak and trifling 
they may appear. 

It frequently happens, that catarrhal complaints, 
even when not exifting to an alarming degree, termi- 
nate, as has been already mentioned, in an affection 
of the lungs known by the name of baftard peripneu- 
mony -, a difeafe which differs much from catarrh in 
its nature, and confequently requires a very different 
mode of treatment. But this change may come on 
fo gradually, and in a manner fo little likely to excite 
the attention of a common obferver, that much mif- 
chief may arife, from not timely adapting the mode 
of treatment to the irritation which has taken place. 

That truly dangerous malady, the croup, is very 
likely, efpecially in the firft ftage, to be miftaken for, 
and treated as, a fimple catarrh, by thofe whofe judg- 
ment has not been formed by obfervation and ex- 
perience. A miftake in this point cannot but prove 
highly injurious ; fince the ordinary remedies for 
catarrh, would prove of no effect in checking the rapid 
progrefs of this dreadful difeafe. 

The 



324 MEDICAL ADMONITIONS. 

The cough, which frequently is very troublefome, 
almoft entirely engrofles the attention of domeflic 
practitioners, who, omitting the necefTary regulation of 
diet, as well as the ufe of means likely to correct the 
febrile ftate of their patients, frequently content them- 
felves with attempting to put a {top to the cough, 
by the exhibition of fome opiate, as the Paregoric 
Elixir ; which, in molt cafes, will not only prove inad- 
equate to the purpofe for which it is given, but will 
feldom fail of confiderably augmenting the difeafe 
itfelf. 

Moft of the noflrums advertifed as cough drops &c. 
are preparations of opium, fimilar to the paregoric 
elixir of the fhops ; but difguifed, and rendered more 
deleterious, by the addition of aromatic and heating 
gums. The injury which may be occafioned by the 
indifcriminate employment of fuch medicines, in this 
difeafe, may be very confiderable ; as is well known 
to every perfon pofTefling, even the fmalleft fhare of 
medical knowledge. 

It would undoubtedly be rendering a great benefit 
to fociety, if fome medical man were to convince the 
ignorant, of the pernicious confequences of their re- 
liance on advertifed noflrums : but, unfortunately, 
the fituation in which medical men ftand, is fuch, 
that their befl intentioned, and moft difinterefted ex- 
ertions for this purpofe, would not only be but little 

regarded, 



MEDICAL ADMONITIONS. 325 

regarded, but frequently would be even imputed to 
bafe and invidious motives. Thofe to whom they 
have to addrefs their admonitions, are, unhappily, 
thofe, on whom reafon has leaft influence. " Prithee, 
Doctor," faid an old acquaintance to a celebrated 
empiric, who was ftanding at his door, " how is it* 
that you, whofe origin I fo well know, mould have 
been able to obtain more patients, than almoft all the 
regular bred phylicians ?" — " Pray," fays the quack, 
" how many perfons may have pafled us whilft you 
put your queftion ?" — " About twenty."—" And 
pray how many of thofe do you fuppofe pofTefTed a 
competent fhare of common fenfe ?"— *' Perhaps one 
out of the twenty," — " Juft fo," fays the Doctor, 
" and that one applies to the regular phyfician ; whilft 
I and my brethren pick up the other nineteen." 

Thofe who have furTered from this difeafe, are, I 
have already remarked, very liable to its future at- 
tacks ; and from what has already been ftated, it 
cannot but be evident, that mofl ferious mifchiefs 
may follow its frequent recurrence. The ftri&eft 
care, therefore, mould be taken, to avoid thofe cir-- 
cumftances, which, a little confideration will fhew, 
may, if not properly attended to, become powerful 
exciting caufes of this difeafe. 

The ill effects of too fuddenly palling into an at- 
mofphere, confide?ably higher or lower in its degree of 

temperature, 



326 MEDICAL ADMONITIONS. 

of temperature, than that which has been juft quitted, 
have been already defcribed, when fpeaking of the 
prevention of inflammation in general. To the ad- 
monitions there given, I muft beg you to revert ; 
with a confidence, that as this circumftance is one of 
the moft frequent caufes of catarrh, an attention to 
what is there delivered may be here of the utmoft 
importance. 

In guarding againft this difeafe, confiderable advan- 
tage is to be gained by a due regulation of the cloth- 
ing. This fhould be neither too thin, nor fo irregu- 
larly difpofed, as to leave one part of the body naked, 
whilft the reft is even loaded by warm clothing. 
In children, and young folks, this error is too 
frequently obfervable. The former we generally fee, 
with their legs and arms uncovered 5 and the necks 
and chefts of the latter are often expofed, unguarded, 
to the utmoft feverity of the cold. " In every 
region, we may obferve external warmth to be nearly 
as neceffary as internal nourifhment, for the young 
of almoft every animal. Warm rooms and impure 
air may enervate the body, but warm clothing can 
never be injurious in cold weather. I am fo tho- 
roughly convinced, that pure air and a warm fkin are 
indifpenfibly neceffary for children, that I never be- 
hold them with naked breafts, legs, and arms, however 
hardy and robuft, that I do not anticipate the horrid 

confequences 



MEDICAL ADMONITIONS. £27 

confeque rices of angina of croup, or of pectoral or in- 
teftinal inflammations." * 

The remarks of Dr. Beddoes on this point are par- 
ticularly interefting, as they are properly directed 
againft a moft filly, but prevailing notion. " In 
children, it is of the utmoft confequence to keep the 
body cool, but never to fuller it to be cold. Thus, 
without being enervated, they may efcape the fatal 
confequences of heat fucceeding quickly to cold ; for 
it is not true, as feems, in confequence of an analogy 
more or lefs diflinctly conceived, to have been fre- 
quently imagined, that cold hardens children as k 
hardens fteel." f 

I never witnefs the cruel perfeverance in this pre- 
tended mode of hardening children, in which the 
weak and fickly hardly ever efcape, but it calls to my 
mind the practice of thole nations, who, determined 
to fecure a hardy race, decree the decriped and infirm 
to be expofed to perifh, in the woods and deferts. 

The ufe of flannel, and of the fleecy hofiery, cannot 
be too much urged as a preventive of this difeafe ; 
but, unfortunately, thofe who think catarrhal affec- 
tions are of too little moment to call for much 
trouble in avoiding them, are generally too ready to 

evade 

* Medical Spectator, vol. i. p. 367. 
i Obfervations, &c. by Dr. Beddoes, p. 16%* 



«2& MEDICAL ADMONITIONS. 

evade the adoption of this meafure, on the mofc 
trifling objections ; the chief of which is, however, 
the uneafinefs arifing from the irritation it occafions 
to the fkin. But rather than the important advan- 
tages to be gained by this mode of clothing mould 
be loft, the flannel may be worn over the fhirt. In- 
deed, in thofe cafes where there has been much 
weaknefs produced by preceding difeafes, or where 
advantage is not expected to be derived from irritat- 
ing the Ikin, this mode of wearing flannel is preferable 
to that of wearing it next the fkin. Remembering 
that it mould be removed at night, with the other 
daily clothing ; and that the fame attention be paid 
to its cleanlinefs, and frequent renewal. 

Thofe who are liable to this difeafe, mould be alfo 
exceedingly cautious in their mode of living. Their 
diet fhould be light and fimple, confifbing more of 
vegetable than of animal fubflances. Milk, in various 
forms, mould conftitute a considerable part of their 
food. Spirituous liquors mould be entirely avoided, 
and wine and beer mould only be taken in fmall 
quantities 3 by children, thefe alfo fhould be quite 
omitted. 

The neceffity of avoiding the air rufhing in a ftream 
from the crevice, or the opening of a door or window, 
muft be fo obvious, as not ta require to be enlarged 
upon. Laying in damp beds, and fitting in wetted 

rooms, 



M3EDICAL ADMONITIONS. 329 

rooms, are fo well known to be productive of injurious 
effects, that it can hardly be necefTary to urge the 
ftrictefl care in avoiding fo open an enemy* 

But there is one negligent, or cruel practice, which 
cannot be too feverely reprehended 5 fince, from the 
frequent instances of dangerous dtfeafes, which have 
been fuppofed to have arifen from this caufe, there is 
too much reafbn to fear, that inattention, in this re- 
iped, is too frequent. Lfirge rooms, which, being 
referved for the purpofe of receiving company, are 
fhut up for mafiy days, and even fometimes for weeks 
together, in damp and cold weather, are frequently 
ufed, with only the precaution of having a fire lighted 
in them an hour or two before the viiitors arrive. The 
fire not having yet fufficiently warmed the room ; 
and the furniture, particularly the curtains, carpeting, 
and chair-feats, being impregnated with a confidera- 
ble quantity of moiflure, which begins to evaporate 
as the room becomes warm, the unfortunate objects 
of this ceremonious, and dangerous diflinction, are 
expo fed to the joint action of cold and moiflure. 
That considerable injury may fohW, there is little 
reafon to doubt ; efpecially as the dreffes of the* 
perfons who are thus expofed to the influence of 
thefe circumftances, are, at thefe times, more light 
and airy than their ufual clothing $ and are, confe- 
quently, but little calculated to defend them from 
fuch powerfully combined adverfaries. 

S s CONVULSIVE 



330 MEDICAL ADMONITIONS. 

CONVULSIVE ASTHMA. 



The ingenious Dr. Robert Bree, of Birmingham, 
was himfelf the object, he fays, of the attacks of this 
difeafe, and might poffibly, he thinks, have had a 
^>rofpect of long complaining of its tyranny, if a de- 
termined refolution to deviate from the common path 
of practice had not occafionally yielded inflruction, 
and given a bafrs for further experiment. From the 
year 1787,116 examined the forms of afthmawith in- 
creafed ihduftry,and was fupplied with more numerous 
opportunities of trying the force of remedies in the 
paroxyfms (having made experiments in one hundred 
and thirty paroxyfms) than can generally occur in a 
practice of ten years, where the motives for enquiry 
are lefs perfonal to the phyfician-. 

From an attentive confederation of the fubjecl:, he 
difcovered, that afthma in general is the confequence 
of irritation of the lungs, and that this may be pro- 
duced by acrid effluvia in the lungs, but is moft fre- 
quently occafioned by an efrufion of ferum in the 
veficulas of the lungs. Other lefs frequent fpecies he 
alfo enumerates ; but thefe it is unnecefTary to notice, 
fmce all that is here intended to be done, is to enable 
you to form fuch an idea of the difeafe, and of the 
caufes on which it depends, as will enable you to fee 
the propriety of the directions for the conduce of the 

patient, 



MEDICAL ADMONITIONS. 33 1 

patient, which I (hall prefume to extract, for the ad- 
vantage of afthmatics. It is far from my intention to 
attempt to furnifh. inftructions to practitioners of both 
fexes, for the cure of this difeafe, being fully con- 
vinced, with the author of this valuable treatife, that 
" No written rules will fupply the defect, which, in 
this diforder, as well as others, the fagacity and obfer- 
vation of experience can alone remedy." 

Wherever indigeftion prevails, which may be known 
by want of appetite, flatulent diftentions and pains of 
the ftomach, heart-burn, &c. there are we to expect 
that afthma alfo may occur. Indeed, fo connected 
are thefe difeafes, that afthma hardly ever takes place, 
but flatulence, and other fymptoms of indigeftion, 
are, at the fame time, difcoverable. 

This circumftance, if duly confidered, muft necef- 
farily imprefs thofe who fuflfer the inconveniences of 
indigeftion with a ftrong conviction of the necemty of 
early oppofing it with requifite remedies ; and of fub- 
mitting to thofe regulations which may be pointed 
out, left the diftrefles ariling from afthma be fuper- 
added. Again, from confidering the dyfpeptic. con- 
dition of patients diftreffed with afthma, and the 
connection which appears to exift between the two 
difeafes, the neceflity of correcting indigeftion, and 
of attending to a proper regimen, muft be very evi- 
dent to t^e afthmatic. 

Errors 



33^ MEDICAL ADMONITIONS. 

Errors in diet, Dr. Bree obferves, are a copious 
fource of inconvenience to the afthmatic. Under 
this head lie fpecifies, drinking too much ftrong 
liquors, or liquors full of carbonic acid, or fixed 
air, with acefcent materials in the compofition, fweet 
wines, and new beer. Profufe indulgence in the ufe 
of tea, and warm watery liquids of all kinds, are ex- 
citing caufes of afthma. Heavy (uppers, eating be- 
tween meals, and, generally, all food of difficult 
digeftion, may produce the fame effecl: ; mch are, 
fmoked meats, paftry, fat pork or beef, water-fowl, 
raw vegetables, fallads, and unripe fruits ; alfo boiled 
cabbage and carrots, rich foups, jellies, and fauces. 

Thefe alimentary fubftances are not readily govern- 
ed by the flomach. of an afthmatic, but remain, till a 
fermenting procefs takes place ; and, if purging or 
vomiting brings no relief, the paroxyfm may be ex- 
cited ; even when thefe evacuations occur, this 
confequence is not often prevented. The afthmatic, 
ht juffcly obferves, muft rigidly believe, that his 
paroxyfms may be more frequent, or the intermiflions 
longer ; according as the feductions of the table are 
too powerful for his prudence, or are refilled by his 
care. Intoxication and furfeit are fo confpicuous 
among the word of his enemies, and can have to little 
allurement where the habit is infirm, that an afthmatic 
is not to be fufpe&ed of fufferiDg from the excite- 
ment ot thefe grofs errors. 

The 



M ED r CA L ADMONI T IONS". % 3 3 

. The atmofphere produces effe&s on the afthmatic, 
by feveral changes. When the mercury in the baro- 
meter flands as high as thirty inches, the denfity of 
the air is fufficient, ceteris paribus, to preferve the 
intermiflion of his diforder ; and alterations from 
this ftandard to a lower, will be, according to circum- 
fiances, unfriendly. Befides a change from this degree 
of denfity, the ftate of the air may be cold or warm, 
cold and moift, or warm and moift j and rain, mow, 
or froft, ftorms and fogs, may give additional impref- 
fion ; but flight in comparifon of the ftate. (the 
diminifhed denfity of the air) which occafions their 
appearances. When vapours hang low, we have a 
certain index of the diminifhed denfity of the air, 
which would otherwife carry them off ; and that the 
caufe of their low fufpenfion is really a ftate of atmof- 
phere, producing, at the fame time, the diforder of 
the reipi ration. 

If to the lightnefs of the air, moifture is added, the 
operation of its influence may be more injurious ■; and; 
has frequently been felt in various fituatfcns, when 
the predifpofition to afthma was not prefent. 

Cold and moijlure check cutaneous perfpi ration, 
and diminifh the heat of the lungs - 3 and is thereby 

hurtful to the afthmatic. 

- 

Cold alone will not ufually excite the paroxyfm, 
though there are ftatesof the atmofphere, which are 

very 



334 MEDICAL ADM0N1TIQNS, 

very injurious, without the pofitive prefence of 
aqueous vapour, or moifture. 

The Eaf and North-E^zvinJs, not only chill the 
lungs, and make their capillaries paflive, and incapa- 
ble of contracting on their contents ; but they check 
cutaneous perfpiration, inducing another caufe of 
althma in catarrh. 

Changes to rain or Jnow affecl: the afthmatic, be- 
eaufe of the decreafe of weight in the air, which gives 
occafion to thefe alterations. 

■S/;;;;^, of any kind, are ufually attended with 
fudden rarity of atmofphere ; and according to the 
prevalence of exceflive heat or cold accompanying the 
change, the afthmatic will be more or Iefs affeded. 

Active motion in a warm air, with frequent refpira- 
tions, produces great increafe of exhalation from the 
fuperficial capillaries, and from the lungs. The difli- 
pation of neat, by this means, is productive of the 
lTjoft fevere fits of aflhma. Heat may be carried 
away from the body, by other means, befides exhala- 
tion ; and this effect takes place in frofty weather, but 
not ufually with the fame confequences to the afth- 
matic. 

Profufe bleeding, fpontaneous or artificial, has 
brought on aflhma, in fome inftances ; and violent 
purging or vomiting may be an exciting caufe of 'the 
parody fm. A 



MEDICAL ADMONITIONS. $j$ 

A critical attention is neceiiary to the calls of the 
ftomach, and the power of that organ to perform di- 
geftion. The firft fhould never be negleded, and 
the latter never opprefted. If the ilomach is loaded, 
the fit will be more violent, than after the occafional 
caufe of failing. The want of foody or an abfurd 
negleft of regular meals, will as certainly excite the 
paroxyfm in fome afthmatics, as a moderate and light 
fupper of tender animal food will alleviate the fymr> 
toms in others. 

Fafting is not only an exciting caufe of afthma, but 
it will, according to its extent, increafe the preclilpo 
fition to the difeafe, by lowering the heat of the body. 

Afudden increafe in the impulfe of the circulation , oae 
caufe of which may be rapid or violent bodily motion,. 
may excite the paroxyfm of afthma. 

The fuppr ejjion of the hemorrhoidal cr menflrual flux 
may occafion dyfpncea, or a paroxyfm of the afthmgl 

Repelled eruptions or g§ut may, according to the 
habit in which the circumftance occurs, produce 
either dylpncea afthma, or peripneumony. 

Duft of any kind, metallic fumes and fetid fmells, 
and ftrong perfumes, fhew their efFe&s on an afthmat- 

xc, by exciting a paroxyfm. 

, 

The frnoh of tobacco is, in moil cafes* offenftve to 

the 



336 MEDICAL ADMONITIONS. 

the afthmatic ; and even when the habit of inhaling 
the fume is purfued, and abfurdly thought to be a 
remedy for the difeafe, by thofe who miftake the 
great excretion of faliva for a neceffary evacuation, the 
patient flrengthens the predifpofition to this difeafe. 
It is affirmed, that fmokers are afthmatic ; and 
•piemerbroeck found their lungs dark coloured, ap- 
proaching to black, and ulcerated. Sir J. Floyer 
mentions a patient, who fmoked to cure a pain in the 
ftomach, and by this means acquired the afthma. 

The trial carbonic acid, ox fixed air, is an exciting 
caufe recorded by Sir J. Floyer. I have known, Dr. 
Bree fays, the infpiring of the vapour of fermenting 
fubftances in brewing, to be followed immediately by 
the paroxyfm. 

The pafiions of the mind may excite a paroxyfm, or 
flrengthen the predifpofition to it. Severe ftudy 
affects the digeftive powers, and therefore promotes 
predifpofition. 

It is not my intention, in a difeafe fo alarming, to 
pietend to furnifh the domeftic practitioner with a 
regular plan of treatment, nor even to particularife the 
feveral remedies which may be demanded in its 
feveral periods. I mail be fatisfied with making fome 
remarks on thofe remedies which are particularly de- 
manded by the diftrefsful ltate of the paroxyfm, and 
which are generally within the reach and management 

of 



MEDICAL ADMONITIONS. Q,2>1 

of domeftic practice ; as well as on fome of thofe 
which alarm may prompt to the employment of, in 
defiance of the probability of dangerous mifapplica- 
iion. 

Emetics are frequently employed with fuccefs in 
abating the violence of the paroxyfm ; efpecially 
where the exiftence of indigeiled matter in the ftomacli 
is pointed out. But much judgment is neceffary to 
enable any one to determine the extent to which the 
operation is to be carried. In fome cafes, ftrong 
vomiting may be neceffary, and in others only naufea ? 
and flight urgings to reach. 

In fevere fits of the fuffocative afthma, the patienfc 
Will frequently infift, in fpite of the ftrongefl remon- 
ftrances, that he may lofe blood, and fometimes with 
fuch a degree of pertinacity as is impoffible to refift. 
But the afthmatic mould conllder this point, in the 
lefs hurried moments of intermiffion ; he mould then 
reafon with his medical attendant, and carefully at- 
tend to his arguments, that his mind may be fo 
armed, as to prevent him from foliciting for, and even 
infifting on, the performance of that which will have 
but little chance of rendering him any fervice, but 
which will, moft likely, occafion an increafe of that 
debility which helped to conflitute the predifpofition 
to the difeafe. Dr. Bree, fpeaking of the effects of 
bleeding in the moft common fpecies of this difeafe, 
Tc fays, 



338 MEDICAL ADMONITION 

fays, " I have repeatedly dire&ed it, but have never 
" had reafon to think that the paroxyfm was fhorten- 
« ed an hour by the lofs of blood ; and I have often 
" been convinced, that expectoration was delayed, and 
" more dyfpncea remained in the intermiffion, than 
" was common after former paroxyfms. In old 
" people, who have been ufed to the diforder, it is 
* certainly injurious." 

The gum ammoniac and fquills, may be frequently 
employed with advantage. But the ordinary oily 
emulfions, and heavy clogging mixtures, are rarely of 
any ufe -, and indeed, by the interruption they may 
occafion to the procefs of indigeftion, they muft, more 
commonly, rather promote than remove the difeafe. 

Bliflers ought not to be employed, in this difeafe 
fo indifcriminately as is generally the cafe. Their 
operation is not fumciently rapid to expect much ad- 
vantage from them, during the paroxyfm j and it 
(hould be remembered, that in every cafe where either 
they or iffues are employed to procure a continued 
difcharge, if the cafe be not fuch as to require evacua- 
tion, injurious weaknefs, in proportion to the dif- 
charge, will be produced. 

The experiments and obfervations, of which I hare 
fpoken when treating of confumption, fhew that con- 
fiderable advantage may be derived from breathing 

air 



MEDICAL ADMONITIONS. 339 

air containing more than the ordinary proportion of 

oxygen. 

The acid of vinegar, diftilled vinegar, or, if that 
cannot be readily^ obtained, common vinegar, in a 
dofe of two table-fpoonfuls, with an equal quantity 
of cold water, is a remedy, from which relief may be 
frequently obtained in the paroxyfm. Dr. Bree fays, 
that in afthma proceeding from the irritation of 
mucus, vinegar is the moft ufeful medicine, in the 
paroxyfm, which I have tried. 

Warm bathing, he remarks, is hurtful in every 
ipecies of afthma : but, he afferts, upon numerous 
trials of its efficacy, that there is no fingle remedy of 
more value, in all fpecies of the complaint, during the 
abfence of the paroxyfm, than the cold bath. 

Having already pointed' out the connection between 
afthma and a weakened ftate of the ftomach, the 
neceffity of having recourfe to thofe means which 
may give tone to this bowel, and thereby affift digef- 
tion, muft be obvious. But the afthmatic mould 
alfo confider, that to accomplifh this end, a patient 
and refolute perfevefance in the courfe of medicines 
which may be prefcribed for this purpofe fiiould be 
adopted. On nothing lefs can any hopes of benefit 
be placed. 

With the hope of preventing returns of the difeafe, 

the 



34© MEDICAL ADMONITIONS. 

the patient fhould be very ftricc in the diet he em* 
ploys. From the obfervations on the caufes of this 
difeafe, above mentioned, the afthmatic will learn 
what errors of diet mould be avoided : and to the 
rules he there obtains, he may add the following. 
His food mould not be generally fluid and poor — . 
watery gruels and broths are therefore improper, the 
flomach requiring folids. Vinous drinks alfo mould 
be avoided. Acidulated water, milk and water, with 
toafted bread or bifcuit j rice boiled in broth until it 
is foft, without fat, are fuited to the paroxyfm. Hot 
liquors are always improper. Cold water is taken 
with great benefit ; and, if acidulated with vinegar, 
its good effects are often very confiderable. 

A flrong infufion of coffee was recommended by 
Sir J. Pringle, as a powerful medicine in the paroxyfm. 
It was alfo fuccefsfully employed by Floyer. Dr. Per- 
cival alio recommends its ufe. Dr. Bree alfo advifes. 
its employment medicinally. 

In juftice to Dr. Bree, I muft here obferve, that the 
leading points in this article are extracted from the 
Doctor's valuable obfervations. It may be confider- 
ed as very advantageous to thofe who labour under 
any particular difeafe, to have an intelligent phyfician 
a fellow fufferer. Independent of the nearer and 
flronger interefl which muft neceflarily impel him to 
the earnefl confederation of the nature of the difeafe, 

his 



MEDIC&L ADMONITIONS. 34I 

his opportunities of investigation are infinitely fuperior 
to thofe of others, whofe enquiries are always likely to 
be productive of lefs information, on account of the 
vague and inconclusive defcriptions contained in the 
anfwers they receive. He is much better able to con? 
ned caufe and effect ; and to mark the confequences, 
beneficial or injurious, which proceed from the feveral 
kinds of diet, the changes of the atmofphere, and 
various qjher circumftances. Having the means of 
experiment always in his power, he is able to employ, 
on the fpur of the moment, whatever judgment may 
fuggeft, or neceflity may demand. In a word, his 
experiments on the difeafe muft be numerous, anc| 
his obfervations conftant 

Should a phyfician prefent to the world his obferva- 
tions, made under thefe circumftances, the benefits to 
his fellow fufferers muft be inestimable : in his pub- 
lication they find a ufeful itinerary, which points out 
to them the roads they mould keep, as well as thofe 
they fhould avoid. It calls their mind from the 
ufelefs contemplation of objects affording neither in- 
struction nor pleafure, and directs its attention to 
thofe which are at once both important and ufeful. 
Such a publication is that from which I have fo. freely 
tal^en the chief of the foregoing practical obfervations. 

HOOPING 



34a MEDICAL admonitions; 

HOOPING COUGH. 



This infectious difeafe is fufficiently known : a 
defcription of it is therefore unneceflary. It may be, 
however, proper to remark, that it often commences 
with the fymptoms of a common catarrhal cough, or 
cold, and may exift fome little time before the charac- 
tereftic hoop is heard. 

There is, perhaps, hardly any difeafe, for which fo 
many noftrums are recommended. Omitting the 
mention of thofe which are fo freely recommended by 
well meaning matrons, I (hall here only allude to thofe 
advertifed noftrums, which, with fo many alluring 
promifes of fuccefs, are artfully foifled on the public. 
From the frequent adoption of thefe, I am well allur- 
ed, the lives of many children are loft ; but previous 
to advancing my reafons for this fuppofition, I will 
make a few remarks on one circumftance, which may 
occaiion parents to place fo much reliance on thefe 
dangerous means. 

This difeafe has no determined period for its termi- 
nation, it difappearing much fooner in fome cafes than 
in others ; but feldom, however, exceeding three or 
four months in its duration. Frequently a happy 
change will take place very fuddenly, and without any 
obvious caufe : the fits becoming more and more 

flight, 



MEDICAL ADMONITIONS. 343 

flight, every day, and the hoop as rapidly declining, 
A difeafe, thus uncertain in its termination, muft be 
very favourable to the character of any noftrum, em- 
ployed with the hope of procuring its removal. 

Suppofe this pretended remedy to be taken by any 
given number of children, and confider, that it muft 
be given either towards the beginning, the middle, or 
the end of the complaint. It muft be fair, then, to 
conclude, that in one-third of thefe cafes, it will be 
given near to that period, when the difeafe would of 
itfelf have gone off. Indeed the proportion might 
be fuppofed to be much greater than one-third, fince 
it moft commonly happens, that in the greater num- 
ber of cafes where thefe noftrum s are had recourfe to, 
the time employed in the trial of other various means 
has brought the difeafe near to the period of its con- 
clufion 3 and the very circumftance of having employ- 
ed fo many things before, without fuccefs, is employed 
to arrogate the more merit to the declared fpecific. 

If no injury were the refult of thefe quackeries, they 
would here have efcaped mention. But during the 
continuance of this malady, there are feveral circum- 
ftances which require fuch particular attention, that, 
if neglected, they will moft probably occafion the 
death of the patient : and, unfortunately, the parents 
relying entirely on the infallibility, which the decep- 
tive advertifement attributes to the mifchievous nof- 
trum 2 



544 MliDlCAL AUMUJNliiuisa. 

trum ; and complying exactly with the terms de- 
manded, that no other medicine be taken, neglect all 
lefs notices of danger, until, feeing their child arrived 
almolt at the point of death, they, too late, apply for 
regular afliftance. 

It is true, that phyficians do not poffefs a fpecifiCj 
which will directly remove this difeafe ; and the ac- 
knowledgment of this, is another inducement to the 
alarmed parent to fly to noflrums ; but they mult he 
informed, that fuch a fpecific will be fought with as 
little fuccefs from the empiric, as from the phyfician. 
The latter is, however, enabled, by an attention to 
the different fymptoms which arife, in the progrefs of 
the difeafe, fo to conduct its courfe, by abating the 
violence of the fymptoms, that it mail rarely proye 
fatal. 

The molt dangerous circumltance that arifes in 
this difeafe, is fhortnefs of the breath ; fince, when- 
ever, this occurs to any confiderable degree, there may 
be great reafon to fufpect, that inflammation of the 
lungs has taken place. In this cafe, bleeding, blifter- 
ing, and other appofite means, adapted to the age and 
ftrength of the patient, will generally afford fpeedy 
relief ; but, on the contrary, fhould any noftrum be 
here relied on, it is molt probable the child would 
foon be loft. So alfo the ipafmodic affection, which 
fo ftrongly marks the difeafe, becomes fometimes fo 

violent 



MEDICAL ADMONITIONS. 345 

violent as to threaten fuffocation, during each fit of 
coughing ; and here the greateft benefit is derived 
from well adapted antifpafmodics. Thus alfo the ac- 
cumulation of phlegm, increafe of fever, &c. demand 
their appropriate remedies ; and common fenfe muft 
be convinced, that all thefe neceflarily varying proper- 
ties, are not likely to be found in one boafted noftrum. 

Much reliance has been placed on removing 
children afflicted with this difeafe into a different air 
from that which they 4iave been accuflomed to 
breathe : beneficial effects, it is faid, have proceeded 
from the change, when even the patient has been re- 
moved into air lefs pure than that he had left. 

Thefe falutary effects, which the experience of 
parents and nurfes, unwarped by hypothecs, has fo 
ftrongly marked, when contemplated by the aid of 
that light which the late difcoveries in pneumatic 
chemiftry afford us, furnifh flrong evidence in favour 
of the employment of airs differing in purity, in feveral 
of the difeafes incident to the human body. 

I have often been furprifed, that this circumftance 
lias not been noticed by Dr. Beddoes, Thornton, and 
other gentlemen, who have made pneumatic medicine 
particularly their ftudy. It has, indeed, not merely 
excited my furprife, it has occafioned my regret ; 
fince the practical deduction I (hall, perhaps, too 
feebly make, might have proceeded from their pens, 
U u with 



346 MEDICAL ADMONITIONS. 

with fuch clearnefs and force, as might have been 
productive of much greater good. 

When treating of confumption, I endeavoured to 
(hew you, that the oxygen, or purer portion of the air, 
is the beft and mofl natural flimulus to the lungs, and 
to the whole fyflem, in thofe cafes, where there exifls 
difficult refpiration, accompanied with a debilitated 
flate of the fyflem : and that the azotic, or more im- 
pure portion of the air, has been found to be highly 
beneficial in the contrary flate of the fyflem ; where 
too much action, manifefled by inflammation, catarrh, 
and fpitting of blood, menance a termination in con- 
fumption. 

In the hooping-cough, both thefe ftates are, at 
different times, found to prevail ; and furely, it is not 
at all improbable, that thefe advantages have been the 
confequence of a fortunate coincidence ; and that, 
where fuccefs has followed the change of air, it has 
been when during an inflammatory flate, the change 
has been for air lefs pure ; and in the contrary Hate, 
where the removal has been from the clofe air of 
town, to the purer air of the country. 

From the foregoing premifes, we have certainly a 
right to conclude, that inflead of indifcriminate 
changes from one lituation to another, the air mould be 
chofen, according to the principles jufl laid down — 
that in thofe cafes where difpofition to inflammation 



MEDICAL ADMONITIONS. 347 

is evident, the impure air of a town mould be pre- 
ferred ; and that, in thofe cafes where a great degree 
of debility, and of difficulty of refpiration, threaten 
dropfy of the cheft, &c. the purer air of the country 
fliould be obtained. 

It can hardly be neceffary to remark, that in thofe 
cafes where the docility of the patient, and the facility 
of procuring the neceffary apparatus, and the required 
air, render the experiment eafy to be made, it will be 
advifable to try the effects of refpiring the hyperoxyge- 
nated air in the one cafe, and of the impure, hydro 
carbonate air in the other. 

That the advice of a phyfician would be defirable, 
to point out the proper plan to be adopted in thefe 
cafes, mufl be very obvious ; and particularly fo, 
when it is confidered, that the medicinal effects of air, 
differing in purity from the common atmofpheric air, 
is but a late difcovery ; that phyficians are not yet 
determined, how much may be fairly attributed to 
their employment -, and that from the induftry with 
which this part of the healing art is cultivated, daily 
information may be expected to be obtained. In 
the prefent imperfect ftate of pneumatic medicine, 
much real fcientific information is neceffary in thofe 
who employ^ el3rfic 

DYSENTERY 
noitenxflififtfti q% nobilodiib sreriw ^Ab-j siodt m 



348 MEDICAL ADMONITIONS. 

DYSENTERY, 

OR 

BLOODY FLUX, 



This difeafe, in general, commences with griping 
pains about the naval, accompanied with a frequent 
defire to void ftools. * Sometimes thefe complaints 
are preceded by cold fhiverings, to which fever fuc- 
ceeds. The gripings and ftools foon become very 
frequent ; the functions of the ftomach become cons- 
iderably impaired ; the appetite is loft; naufea, fick- 
nefs, and fometimes frequent vomitings, take place. 
The ftools are in fmall quantities, and compofed 
aimoft entirely of mucus ; at times mixed with blood, 
which in fome cafes appears in the mucus, in ftreaks ; 
and, in others, pure and unmixed. Small pieces of 
membranous films, and hardened excrement, are alfo 
obfervable in the flools, which are highly ofTenlive, and 
of a fmell peculiar to this difeafe. In general, the 
difeafe is accompanied, through its whole courfe, by 
a fever of a malignant kind •> but fometimes, the fever 
foon leffens, although the dyfenteric fymptoms con- 
tinue. 

Children and aged perfens, and thofe who have 
been weakened by former difeafes, are much endanger- 
ed by attacks of this difeafe 5 and even thofe who are 

ia 



MEDICAL ADMONITIONS, 349 

in the prime of life, are frequently fo affected by it ? 
as to give very juft caufe of alarm, 

If the gripings become more fevere, and the ftools 
more frequent, whilftthe quantity difcharged by them 
diminishes j efpecially if the fever increafes, the difc 
eafe may be concluded to be getting worfe. If the 
gripings ceafe entirely, and the difcharge is of a dark 
fanious matter, the pulfe becoming exceedingly fmall 
and quick, and the patient covered with a profufe 
cold fweat, a gangrene may be fuppofed to have taken 
place, and aJpeedy diffolution may be expected. 

A favourable termination may be hoped for, when 
the gripings and ftools become lefs frequent, and the 
difcharge arTurnes a natural appearance. 

It however frequently happens, that after the diK 
eafe has aflumed a more favourable appearance, and 
the patient is fatisfied that his recovery is almoft com- 
plete, the difeafe will continue without any farther 
amendment ; inducing a train of difeafes, which, 
unlefs well adapted means are employed, mull be 
productive of much ferious mifchief. 

It too frequently happens, that this difeafe is allow- 
ed to exift for fome time before the patient, who 
fuppofes it a common loofenefs, acquires a knowledge 
of the nature of his complaint ; in confequence of 
which it is permitted to run on until it becomes fo 

inveterate, 



350 MEDICAL ADMONITIONS* 

inveterate, and the patient fo much weakened, as to 
render the cure very difficult to accomplifh. 

To conduct a patient fafely through this difagreea- 
ble and alarming difeafe, demands much care and 
fagacity on the part of the phyfician, and the ftricteft 
attention and moft implicit obedience from the at- 
tendants. The cure of this difeafe depends in a great 
meafure, on the removal of the excrements which are 
morbidly retained in the bowels -, and, confequently, 
on the producing a faecal difcharge of a natural ap- 
pearance. To effect this, purgative medicines, with 
occafional clyfters, mould be employed. But this 
mode of practice is very little likely to be followed by 
domeflic practitioners, who cannot be made to com- 
prehend the principle on which it is founded. To 
them it will appear, not only incompetent, but even 
fevere and injurious. They cannot conceive how a 
purging is to be removed by increafing the difcharge ; 
or how griping pains are to be leflened, but by the 
ufe of warm and aromatic remedies. They therefore 
often take the liberty, not only to fufpend the ad- 
miniftering of the remedies prefcribed j but to fubfti- 
tute for them thofe things which, in their opinion, 
will fooner remove the fymptoms : endeavouring to 
flop the purging by the moft powerful aflringents, 
and to lefTen the gi'ipings by aromatic and fpirituous 

drinks. 

So 



MEDICAL ADMONITIONS. §J1 

So far is it from being fafe to truft the management 
of this difeafe, to any one whofe only knowledge 
refpe&ing it is derived from fome treatife on domcftic 
medicine, that it is difficult to convey to fuch, infor- 
mation fufficiently explicit, on the article of diet 
alone, to enable them to adapt it to the different cafes 
of this difeafe. The age and ftrength of the patient, 
the ftate of the fyftem, and the different ilages of the 
difeafe, all require to be confidered, before a . fit regi- 
men can be determined on. 

If the difeafe be accompanied by inflammation, the 
food fhould not only be confined to a liquid form ; 
but fhould alfo confift of thofe things which are 
fimple, and are of a cooling nature ; fuch as barley- 
water, thin panada, or thin gruel, made from flour or 
rice, &c. &c. Where there are no marks of inflam- 
mation, the diet may be more nutritive ; but fhould 
ftill confift chiefly of liquids. To the articles above 
mentioned may be added broths of various kinds, 
calves feet jelly, &c. If the fever accompanying the 
difeafe is of a putrid nature, the patient fhould take 
freely of ripe fruits, the juice of ripe oranges, and 
Currant jelly, may be added to the drinks. In gene- 
ral, the diet may be more nourifhing, after the difeafe 
has exifled fome time ; and particularly fo, if the 
patient has been weakened by preceding difeafes, Or 
is either of a tender or an advanced age. 

The 



3£i MEDICAL ADMONITIONS. 

The chamber fhould be frequently fupplied with 
frefh air, and filled with the fumes of vinegar, he. 
The clothing of the patient, as well as the bed-clothes, 
mould be frequently renewed ; and every thing pro- 
ductive of ofTenhve frnell fheuld be removed as 
fpeedily as poffible. 

To prevent a return of the difeafe, to which the 
patient will be liable, moderate exercife may be em- 
ployed in the open air, in that degree, and in that 
mode, which his ftrength will permit. A tea-cupful 
of camomile tea, or of decoction of bark, may be 
taken three times a day. The diet mould not confift 
too much of animal food ; and fpirituous and fer- 
mented liquors mould be entirely avoided. The 
bowels mould be kept in a ftate of regularity, and 
fhould be guarded from cold by additional clothing. 



APOPLEXY. 



In this difeafe, the whole of the fenfes, and of the 
voluntary motions, are in fome degree abolifhed, 
whilft the actions of the heart and lungs continue. 
The appearance of the patient is that of one in a deep 
fleep ; the breathing being moftly accompanied by a 
loud fnoring. The face is generally fwelled, and of a 
dark florid colour, every veflel about the head and 

neck 



MEDICAL ADMONITIONS. 353 

neck appearing to be diftended with blood. The eyes 
are bloodfhot, watery, and prominent ; and frequent- 
ly the head, and the whole body, is bedewed with a 
cold clammy fweat ; and a paralytic affection of one 
fide of the body is frequently found, at the fame time, 
to have taken place: 

Sometimes this difeafe comes on fuddenly ; but 
moft frequently it is preceded by thefe fymptoms. 
The face, for fome time before, appears more than 
ufually florid, and the eyes flightly bloodfhot. The 
head is giddy, and frequently affected with paim par- 
ticularly in the back part of it. The extremities alfo 
are frequently affected with numbnefs, and irregulari- 
ties, or inability of motion ; and fometimes a little 
faltering of fpeech may be difcoverable. The patient 
is almoft conftantly drowfy, and generally fleeps par- 
ticularly found j but is fometimes affected with fits 
of the incubus, or night-mare. A troublefome ring- 
ing noife is frequently perceived in the ears ; tranfient 
irregularities, both in fight and hearing, are frequent- 
ly difcovered, and every fenfe appears, at times, to be 
fomewhat impaired. Recollection, reflection, and 
every other procefs of the mind, is performed, evident- 
ly with lefTened power. 

The fubjects of this difeafe, are, generally, perfons 

in an advanced flage of life. Thofe have been ob- 

ferved to be particularly difpofed to it, who are of a 

W w corpulent 



354 MEDICAL ADMONITIONS; , • 

corpulent habit, and have a large head and fliort neck.' 
Indolence, and indulgence in the luxuries of the table, 
as well as the fuppreffion of any difcharge, which, by 
its length of continuance, has been fuffered to have 
become habitual to the con ft i tut ion, contribute much 
to the forming of a predifpofition to this difeafe. 

Whatever interrupts the return of the blood from 
the head ; or, by impeding its circulation through the 
other parts, throws it in too great quantity upon the 
brain, may prove an exciting caufe of this difeafe 5 
fmce the moil frequent immediate caufe of apoplexy, 
is the accumulation of blood in the blood-veffels of 
the brain, or an effufion of blood, or of fome other 
fluid, in different parts of the brain, or between it and 
the bones of the fkull. Every violent exertion, 
therefore, efpecially if accompanied by a full and long 
continued infpiration ; a considerable degree of fatigue, 
exceflive heat, or cold ; a violent fit of coughing ; 
long continuance in a ftooping pofture, or with the 
neck in an oblique pofition y any thing worn tight 
about the neck j intoxication, exceflive diflenfion of 
the ftomach and bowels, and violent emotions of the 
mind, may occafion this difeafe. It may alfo be pro- 
duced by various other changes, which may take 
place within the cavity of the fkull ; the nature of 
which cannot be precifely afcertained during life. 

In addition to the caufes of apoplexy here enume- 
rated^ 



MEDICAL ADMONITIONS. ^SS 

rated, feveral others have been mentioned by different 
authors ; fuch as the receiving the exhalations from 
newly plaiftered walls, the mephitic air arifing from 
fermenting liquors, the fumes arifing from burning 
charcoal, brimftone, &c. from lead, arfenic, and feveral 
other fubftances ; but the difeafes induced by thefe 
caufes being very different from apoplexy, and con- 
sequently requiring a different mode of treatment, 
will be fpoken of feparately. 

In a difeafe, the caufes of which are fo various, and 
oftentimes fo difficult to afcertain ; wh'ofe mode of 
attack is always fo alarming, and whofe termination is 
generally fo fatal, the earlieft ufe of every effort, pointed 
out by ftudy and experience, muft be adopted. To 
attempt to furnifh family practitioners, therefore, with 
rules for the cure of apoplexy, would be abfurd and 
dangerous : all that with propriety, therefore, can be 
attempted in a work of this kind, is to manifefl the 
neceffity of obtaining the earlieft medical aid ; to 
recommend the fafeft mode of treating the patient, 
until that is obtained ; and to point out the moft 
proper plan to be adopted, to prevent the return of 
the difeafe. No time, then, mufl be loft .: the beft 
medical afliftance mould be obtained, as foon as 
poffible ; fince, in every moment that is wafted, 
the difeafe is, moft probably, more firmly eftablifhing 
itfelf. In the interim, no ram experiment, nor any 

violent 



356 MEDICAL ADMONITIONS. 

violent endeavours, fhould be employed. The appln 
cation of irritants to the noftrils, as volatile falts, 
fnufT, &c. with the hope of routing him from his 
flate of infenfibility, muft be particularly forborne, as 
well as any attempts to force him to (wallow any h> 
ritating liquors. 

The patient fhould immediately be raifed into an 
elevated pofture, and his head, in particular, mould 
be kept erect ; fmce, otherwife, an angle being form- 
ed by the bending of the neck, the blood will be the 
more likely to be detained in the blood-vefTels of the 
brain ; which, of neceflity, muft occafion an augmen- 
tation of the difeafe. The neckcloth, and whatever 
is likely to occafion a ftricture on any part of the 
body, muft be removed, 10 that no interruption to the 
free circulation of the blood may exift. The air of 
the room fhould be moderately cold ; and the cloth- 
ing fo difpofed, as to allow the patient to breathe the 
cool air, at the fame time that the body itfelf may be 
iuiflcicntly defended from the action of the cold on its 
furface. In removing the patient to his chamber or 
bed, great care mould be taken, that he be ftirred no 
more than is abfolutely neceflary ; and that an erecl; 
polition be preferved as much as poflible. Should the 
patient have been feized foon after eating a hearty meal, 
and fhould frequent urgings point out a difpofition to 
retch, the difcharge of the contents of the ftomach 

may 



MEDICAL ADMONITIONS. 357 

may be procured, by irritating the throat and fauces 
with the end of a feather ; iupplying him, as foon as 
he is able to fwallow, with camomile tea, fait and 
water, warm water, &c. until the ftomach is quite 
emptied. This mould, however, be performed with 
caution : if the eyes are very red, and the face exceed- 
ingly florid and turgid, it ought not to be attempted, 
until fome blood has been taken away. 

From a confidence in ics utility, in every cafe of this 
difeafe, bleeding is almoft always immediately pro- 
pofed, by thofe who happen to be prefent at the firfb 
onfet of the difeafe ; and is generally adopted, if any 
one can be found who can wield a lancet. And, in- 
deed, not only in this difeafe, but in every other, 
which menaces the fpeedy extinction of life, is this 
operation too generally had recourfe to. To prevent 
the rath and dangerous adoption of this practice, it 
may be fufficient to inaprefs on the mind, that thefe 
alarming fituations may oftener depend on a depletion 
of the blood-venels, and an exhauftion of the vital 
powers, than on too great fulnefs, or on too powerful 
action. Even in the difeafe, which is the fubject of 
the prefent fection, in which it muft be acknowledg- 
ed, that bleeding is more frequently demanded than 
in any other difeafe, which has for its characteriftic 
fymptoms the deprivation of fenfe and motion, the 

obfervation? 



358 MEDICAL ADMONITIONS. 

obfervations of the moft celebrated phyficians have 
proved, that bleeding is fometimes highly injurious.* 

The heft advice, therefore, that can be here given, 
with refped to bleeding, as a rule of conduft in thefe 
diftrefsful cafes, is, perhaps, to abftain from this 
operation, until the opinion of the intelligent can be 
obtained. 

This delay will be efpecially necefTary, if the coun- 
tenance appears to be funk and pallid, rather than 
tumid and florid ; if this attack has occurred at the 
clofe of long continued labours, either of the mind or 
body ; and in fubjecls who have not been devoted to 
indolent or luxurious indulgences. 

A fimilar caution is necefTary, with refpect to the 
employment of blifters, which, from an opinion of the 
iafety with which they may be ufed on all occafions, 
are often had recourfe to in thefe cafes. But, it mult 
be here remarked, that their employment is admiffible 
only in feme cafes ; in others, every alarming fymp- 
tom may be increafed by their application. 

It has been already remarked, that there is a certain 
peculiarity of make, which very much difpofes to this 

difeafe'j 

* Heberden. Medical Tran factions, vol. i. p. 471. 
Fothergill. London Obf. & Inq. vol. vi. p. 680. 
'Kirkland's Commentary en Apople&ic and Paralytic 
Affections, p. 46. 



MEDICAL ADMONITIONS. %$$ 

djfeafe ; this was faid to confift chiefly in a fhortnefs 
of the neck, and a largenefs of the head, accompanied 
by a full habit of body, and a florid countenance, 
I muft here digrefs, for the fake of leflfening unnecef- 
fary uneafinefs and alarm, which may be excited, in 
thofe who may conceive they poflefs, in fome degree, 
this peculiar form. 

This peculiarity, it muft be obferved, then, only 
gives a greater fufceptibility of this difeafe ; and this 
by no means to the extent which has been generally 
fuppofed. The difeafe itfelf, and even a difpofitioa 
towards it, muft be produced by a concurrence of 
various circumftances, the greater number of which 
may be removed^ or prevented, by a little care and 
refolution. 

When it is recollected, that a frequent caufe of 
apoplexy is a mechanical preffure on the brain, the 
confequence of the accumulation of blood in the 
blood-veflels of the brain ; or of the extravafation of 
blood, or of fome other fluid, in or upon the brain 5 
it is obvious, that, to prevent fuch a fulnefs of blood 
arifing, as may deftroy the equilibrium between the 
blood-venels and their contained fluid, mould be the 
confiant endeavour of every one who has reafon to 
fear an attack of this diforder. 

To effect this, it will be neceflary that a due pro- 
portion 



*6b MEDICAL ADMONITIONS* 

portion be preferred, between the quantity of nourim- 
ment which is taken, and the wafle which is occafioned 
by exercife. The patient ihould therefore be very 
fparing^n his meals ; of which animal food mould 
form but a very fmall part. Spirits, wine, and the 
ltronger kinds of malt liquor, as porter and ale, mould 
be ftridtly avoided. The beverage ihould chiefly 
confift of lemonade, flierbet, whey, butter-milk, &c< 
and, where fome indulgence to long eftablifhed habits 
is infifted on, weak negus, or a glafs or two of port, 
or of the lighter French wines, may be allowed after 
dinner. 

The clothing mould be light and loofe ; and par- 
ticular care mould be taken, that nothing the leafl 
tight be worn about the neck. 

Exercife mould be employed to a confiderable ex- 
tent, and no more fleep indulged in, than is jufi fuf- 
ficient to recruit the ftrength. Sleeping immediately 
after a full meal mould be carefully avoided : efpeci- 
ally fleeping in a chair, which is particularly danger- 
ous ; fince, in confequence of the mufcles which 
fhould fupport the head lofing their power, during 
fleep, the head falls on one fide, by which, the blood- 
velTels in the neck being compreffed, the return of the 
blood from the head may be impeded, and a rupture 
of fome of the veffels in the brain be thereby pro- 
duced. 

A 



MEDICAL ADMONITIONS. 361 

A confiderable number of thofe.who fall victims to 
this difeafe, are attacked during the night ; this 
may be accounted for, by confidering, that the hori- 
zontal pofition impedes the return of the blood 
through the jugular veins ; its motion being no 
longer aided by its gravity, which was the cafe whilft 
the body was in an ered pofture. For this reafon, 
the beds of thofe who have caufe to fear an attack 
of this diforder fliould be coniiderably higher at the 
head than at the feet. This rifing of the bed fhould 
be gradual, fuch as would be occafioned, by fhorten- 
ing the fupporting polls at the foot of the bed j fince 
if it be attempted only in the ufuai way, by three or 
four pillows, in addition to thofe ufually employed to 
raife the head, the chin will be thrown forward on the 
cheft, and the neck bent at fo acute an angle, as may 
be very likely, during'the hours of fleep, by interrupt- 
ing the paflage of the venal blood, in the neck, to 
bring on thofe very effects which it was intended to 
prevent. 

The man of bufinefs, who for his cares and exer- 
tions has obtained the reward of eafe and competence, 
is particularly fubjed to this malady. In him we find 
the concurrence of many circumftances, which mufl 
have a tendency to produce this \fifeafe. In the days 
of his induftry, when conftantly labouring, perhaps 
literally- fo, to obtain the gains of his bufinefs or pn> 
X x feffion, 



362 MEDICAL ADMONITIONS. 

feflion, the necetfary exercife, both of body and mind,, 
muft, from the great expence of the vital fluid, 00 
cafion the demand of conliderable fupplies of nourifh- 
ment ; and we, in general, find, that men of the above 
defcription are favoured with organs of digeftion in a 
found and vigorous ftate, and are confequently well 
difpofed towards the luxuries of the table. 

Such a man feldom quits the pleafing buftle of a 
fuccefsful bufinefs, until he difcovers, that he has fo 
far paiTed the acme of his life ; that his abilities are 
not what they were, and that his exertions are no 
longer productive of that fuccefs which he has hither- 
to experienced. However difpofed he may be, at firft, 
to attribute this to other caufes, it will not be long 
before he discovers the true caufe, in the diminifhed 
vigour, perhaps both of body and of mind. 

He retires, therefore, from the bufy world, with 
the intention, either of freely indulging himfelf with 
that reft, to which his purfuits, followed with avidity, 
have hitherto rendered him a ftranger ; or, at leaft, 
of exchanging his exercife and his employments, for 
fuch as may be more agreeable, and better fitted to 
his declining years and flrength. 

If we follow him in his retirement, we fhall moft 
probably find him indulging in almoft a ftate of ab- 
iblute indolence - 3 or, at leaft, in a ftate comparative- 
ly 



MEDICAL ADMONITIONS. 363 

ly {o y if the adive fituation from which he has been 
removed, be recollected. 

Although he may, for his health's fake, being aware 
of the ill confequences of the omiffion, make a point 
of taking fome exereife -, yet it is moft likely that 
this will not be employed to that extent, which is 
neceffary to prevent the evils intended to be avoided. 
This may arife from his varying his modes of exereife, 
when he changes his fituation of life. Thus, whilffc 
engaged in his former purfuits, we may fuppofe him 
to be almoft conftantly on foot, hurrying to wherever 
he may be fummoned, by the various calls of his 
bufinefs or profemon. But after his retirement, he 
will moft probably adopt, for his amufement, fuch 
exercifes as will confiderably differ from that to which 
he has hitherto, in fome meafure, been impelled. 
The culture of a flower-garden, riding on horfe-back, 
or even the regular ringing of dumb bells, may be 
adopted ; but without anhVering the propofed inten- 
tions. To understand the reafon of this failure, I 
muft beg you to confider, that if any {tt of mufcles 
are employed, in a different manner, and in a different 
combination, from that to which they have been ac- 
cuftomed, a fenfe of wearinefs and pain is foon ex- 
perienced in them. Bend but the neck flrongly to 
one fide, and retain it there a few minutes, this fact 
will be foon fufneiently evident. Thus, though the 

gardener 



364 MEDICAL ADMONITIONS. 

gardener may delve from morning till night, with little 
or no inconvenience ; and the veteran fportfman may 
follow the longeft and hardeft chace, with delight ; he 
who has been unaccuftomed to thefe modes of exer- 
cife, would, by employing them, not only foon become 
inexpreflibly wearied ; but would probably not get 
rid of the painful affection of the mufcles, for feveral 
days. In this way, an important deception may take 
place ; for reckoning his exercife by the quantity of 
fatigue he experiences, he may fuppofe it to be equal 
to that which ufed to be afforded, by fo much of his 
former amufements, as was productive of a fimilar 
degree of wearinefs. Whereas, on the contrary, al- 
though his fatigue may be confiderable, his exercife 
may have been fo trifling, as to have yielded no bene- 
ficial effect. 

But mould he, after his retirement, even perfevere 
in a limilar mode of exercife, with that to which he 
has been accuiiomed (of walking for inftance,) it is 
very likely, that for want of an object fufficiently im- 
portant and interesting to engage his attention, he 
will too acutely feel the many little inconveniences 
and troubles, which continually arife, to teize a mind 
which is too little occupied. In confequence of 
which, he will foon yield to a fenfe of wearinefs 3 and 
will endeavour to convince himfelf, that he has taken 
the full quantity of exercife, which had been allotted 
him. Were 



MEDICAL ADMONITIONS. $6$ 

Were he to leffen the quantity of his food, in the 
fame proportion as he diminifhes his exercife, little or 
no evil might arife ; but, unfortunately it fometimes 
happens, that the mere habit of eating plentiful 
meals, may continue the cuftom ; even when the ap- 
petite itfelf does not demand them : and long after 
the various modes of exercife have been given up, by 
which the neceffary balance mould be preferved. 

In a word, then, perfons of the above defcription 
ihould change their modes of living gradually, and 
with the greateft circumfpe&ion : their minds mould 
be almoft conftantly engaged, in lome purfuit or 
amufement, which may keep off the attacks of languor 
and liftlefTnefs ; and the utmoft care Ihould be taken, 
that a due proportion be preferved between the food 
they take, and the exercife they employ. 

But it is not the fuccefsful and high fed citizen 
alone, that is obnoxious to the attacks of this difeafe- 
It frequently marks for its victims, objects of a very 
different defcription — thofe who devote their hours 
to the moft fevere and obftrufe ftudies ; and particu- 
larly thofe who may have long ftruggled with adverfity 
and difappointment ; and whofe minds have been 
conftantly harraffed with anxious attention to fpecula- 
tions 5 which at laft have involved them in ruin. 

PALSY, 



366 MEDICAL ADMONITIONS; 

PALSY. 

~"~ """""" 
Palsy confifts in a lofs of the power of motion, 
but affecting certain parts of the body only. 

The different forms in which this difeafe appears, 
are diftinguimed by different names, according to the 
parts which are affected : thus, if the lower part of the 
trunk, as well as the inferior extremities, are affected, 
the difeafe is termed paraplegia :• if one fide of the 
body is affected, with the limbs on that fide, the dif- 
eafe is then named hemiplegia. 

Such perfons as have been already defcribed, in the 
preceding chapter, as predifpofed to attacks of apo- 
plexy, are alfo very liable to paralytic affections. 
Thofe who lead fedentary and luxurious lives -, who 
have been much engaged in night ltudies, and watch- 
ings ; and have fuffered much diftrefs and anxiety, 
are frequently the victims of this malady. It feldom 
comes on before the middle ftage of life is paft, and 
has been thought to happen more frequently to fe- 
males, than to men. Extreme coldnefs and dampnefs 
of the atmofphere, appear to be favourable to the 
production of this difeafe ; fince attacks of palfy, 
as well as apoplexy, are very frequent at the nrfl 
fetting in of winter. The immoderate ufe of fpiritu- 
ous liquors, tobacco, coffee, and tea, will be likely to 

promote 



MEDICAL ADMONITIONS. 367 

promote the production of this complaint. Similar 
effects may be alfo produced by quickiilver, lead, ar- 
fenic, and other mineral fubftances $ either by the 
unfkilful employment of them as medicines, or by the 
neceffary expofure to their action, in the various arts 
in which they are employed, fuch as gilding, the 
fufing of metals, painting, &c. Sudden and violent 
guffs of paffion, and other considerable affections of 
the mind, may alfo induce this difeafe. 

The difeafe fometimes comes on without any pre- 
vious fymptoms, the patient having appeared, but juft 
the minute before, as in perfect health ; but it more 
frequently happens, that, for feme time before, the 
patient has complained of pain, and of giddinefs and 
weight of the head ; and frequently of a general lan- 
guor and liftleflhefs 1 the powers of the mind alfo 
feeming, in fome meafure, to be impaired. 

When the difeafe has taken place, the pulfe, as in 
the apoplexy, becomes, in general, hard and full, and 
moderately quick ; fometimes it is flower than natu- 
ral, and fometimes very irregula^and even intermit- 
ting. The limb affected drops ufelefs, and becomes 
pale and cold ; and is almoft always, at the firft, in a 
clammy fweat j fometimes a painful prickling fcnfa- 
tion is felt, exactly refembling that which occurs when 
the leg is faid to be afleep ; and in other cafes, the 
parts, affected are deprived of the fenfe of feeling, as 

well 



,68 MEDICAL ADMONITIONS. 

well as of the power of motion. Apoplectic fymp- 
icms frequently accompany the diieafe at the firft 
attack ; but thefe fometimes fubfide, and leave the 
patient affected with the paralytic fymptoms only. 

When a fenfe of tingling is felt in the parts affect- 
ed, and the parts regain a final 1 degree of motion, a 
hope may be reaibnably entertained, that a considera- 
ble change for the better may yet take place. This 
expeftation may be the more indulged, if no giddi- 
nefs, head-ach, or preternatural fleepinefs, remain ; 
cfpecially if the patient feems to be regaining the 
powers of recolledion, thought, &c. 

The danger with which this diieafe is known always 
to be accompanied, and the formidable manner in 
which its attacks are generally made, cannot fail but 
imprefs the mind of the patient, and his attendants, 
fo ftrongly, as to render it entirely unnecefiary here, to 
ufe any arguments againft the folly of having recourfe 
to the futile, or dangerous attempts of domeflic 
medicine. 

On the firft onfet of the difeafe, and before proper 
medical aid can be obtained, the cautions laid down 
in the preceding fe&ion will be very proper to direft 
the management of the patient. 

A* foon as the difeafe is fu&ciently leiTened, to 
allow of the patient's making ufe of exercife, it mould 

be 



MEDICAL ADMONITIONS. 369 

be cautioufly and regularly employed 5 but great care 
mould be taken, that it be of that kind, which is bell 
adapted to his ftrength and former habits. 

Electricity is almoft always had recourfe to, in this 
malady, and too often without firft obtaining the 
neceffary information, from thofe who alone are capa- 
ble of giving it, as to its propriety or impropriety. 
It is too generally fuppofed, that, although electricity 
may produce no beneficial effects by its application, 
in cafes of <3ifeafe, yet it cannot be productive of any 
injury to the patient. But the contrary of this is the 
truth ; for electricity, it is well known, is capable of 
producing very confiderable, and very different effects 
on the animal fyftem ; for at the fame time that it is 
one of the moft powerful ftimulants that can be em- 
ployed, it is alfo pofTeffed of the power of rapidly 
deftroying the mobility of the nervous fyflem. 

In cafes, therefore, where the difeafe depends on a 
furcharge of the veifels of the brain, how dangerous 
muft be the ralh employment of fo powerful a ftimu- 
lant ! Again, when its debilitating effects are confider- 
ed, how evidently it appears, that in cafes of debility, 
it muft: of neceflity occafion the farther diminution of 
the vital powers ; and thereby produce an increafe of 
the difeafe it was meant to remove, and perhaps the 
fpeedy death of the patient. Cafes are not wanting, 
where the increafe of jpaliy has been manifestly the 
Y y confequence 



370 MEDICAL ADMONITIONS. 

confequence of employing electricity, with the hope 
of its removal. 

" That the electric fluid acts as a ftimulus upon 
the animal iyftem, muft, I believe be allowed j but 
that its ftimulant effects are more tranfient, and the 
fucceeding ftate of debility confequentfy more rapidly 
produced, than what remits from the application of 
any other known ftimulus, muft, I think, be alfo 
allowed." * 

Dr. Falconer, in the fame work, obferves — " Elec- 
tricity has often been recommended as a remedy ia 
palfy, and much cried up by fome that pretend to 
fecrets in the mode of adminiftering this remedy. 
But the medical faculty have, I believe, nearly loft all 
faith in it, from experience of its general inefEcacy to 
be of fervice, and in fome inftances, of its mifchievous 
effects. I am more certain that a ftrong electric fhock 
pofleffes the power of caufing a palfy, than I am of its 
having any power to cure it. We have lately had 
two inftances in the Bath hofpital, of perfons who had 
paralytic attacks after being ftruck with lightning." -J» 

Dr. Falconer alfo obferves, that it is a frequent 

practice 

* An Account of the Effects of Lightning, by j. Parkin- 
fon, Hoxton. Memoirs of the Medical Society of London? 
vol. ii. p. 493. 

t Ibid. p.2ou 



MEDICAL ADMONITIONS; 37 1 

practice to lap up paralytic limbs in many folds of 
flannel, and to keep the perfon fo affe&ed, very warm 
an every refpect. But this is, undoubtedly, a very 
noxious practice, as it generally induces a ten- 
dency to fweat on the paralytic part; which always 
weakens it. 



FAINTING. 



In this difeafe, the circulation of the blood, and 
the action of the lungs, become fo much weaker than 
natural, as in feme cafes, to give reafon to fufpect 
that they are entirely fufpended. 

When the difeafe does not come on fo fuddenly as 
to deprive the patient, at once, of his fenfes, he ex- 
periences a fenfe of pain and oppreflion, about the 
region of the heart ; accompanied with exceffive lan- 
guor, and frequently with ficknefs. He fees very 
imperfectly the objects which furround him, which all 
ieem to be polTeffed with a rotatory motion, and at 
the fame time his ears are affected, with a confuied 
ringing noife. Every part of the body, but particu- 
larly the face and extremities, become cold and pale ; 
and are frequently covered with a profufe cold fweat. 
The powers of fenfe and motion are always impaired 
in fome degree, and fometimes entirely fufpended for 
a time : the pulfe, as well as the breathing, being, at 

the 



37 2 MEDICAL ADMONITIONS. 

the fame time, fcarcely, if at all, to be perceived. 
After the fymptoms have thus continued a few min- 
utes, they gradually difappear ; a difcharge of the 
contents of the ftomach fometimes comes on, and 
fometimes the fainting is fucceeded by convulfions. 
In moft cafes, if proper means are not had recourie to, 
a recurrence of the difeafe may take place. 

Of the numerous caufes of fainting, the more fre- 
quent, need only be enumerated ; thefe are, fudden 
and profufe haemorrhages, irregular diftributians of the 
blood, immoderate difcharges of various kinds, violent 
exertions, exceflive pain, fudden or violent paffions 
or emotions of the mind, difgufling fights, difagreea- 
ble odours, long continuance in heated rooms, de- 
bauches, &c. 

A difpofition to this difeafe may take place where- 
ever debility exifts ; but when this difeafe frequently 
recurs, without any obvious caufe, a morbid ftate of 
the heart or brain themfelves is to be fufpedled. 

The treatment of the patient reflects either the 
fhortening of the paroxyfm, or the preventing of its 
recurrence. 

The firfl of thefe intentions may, in general, be ac- 
complifhed, by adopting the following means. The 
patient mould be placed in a reclined pofture, and 
every part of the clothing, which, by its tightnefs, is 

likely 



MEDICAL ADMONITIONS. 373 

likely to interrupt the free circulation of the blood, 
/hould be immediately loofened. No more perfons 
mould be allowed to be in the room, than are abfo- 
lutely neceffary, from the affiftance they may yield ; 
and thefe mould fo difpofe themfelves, as not to in- 
terrupt the free accefs of the air to the patient. The 
doors and windows of the room, efpecially if the 
weather be warm, mould be kept open ; or, if the 
room be fo fituated, as not to allow of fuiiicient air being 
thus obtained, the patient may then be removed into 
the open air. The face may be fprinkled with cold 
vinegar, or water. The fmoke of burnt linen cloth, 
vinegar, and any pungent vapour, particularly that of 
volatile falts, may be applied to the noftrils ; but in 
doing this fome management is neceffary ; fince, 
without care, the intended effects will not be pro- 
duced. 6 A 

If the patient retains fenfe enough to experience 
any inconvenience from the application of pungent 
vapours to the noftrils, but not fufHcient judgment 
to be aware of the neceffity of inhaling them, the ut- 
moft exertions will be made by him to infpire through 
the mouth only ; excluding the air thus impregnated, 
as much as poffible, from the noftrils. It is ulual to 
qbferve patients, in this ftate, thus bear the applica- 
tion of fmelling bottles filled with the moft pungent 
and volatile remedies, for a long time together, with- 
out 



574 MEDICAL ADMONITIONS.' 

out feeming to be at all affected by them. In thefe 
cafes the mouth is to be clofely flopped, by holding a 
handkerchief forcibly againfl it, but leaving the 
noflrils perfectly free. The patient being now under 
the neceffity of breathing through the noflrils, the 
effluvia which are employed, are impelled againfl the 
membrane which lines the cavities of the noflrils, and 
on which are difpofed the fentient extremities of thp 
olfactory nerves. Frequently it will be obferved, 
when recourfe is had to this mode, that the patient 
will for a long time refrain from breathing at all ; 
but at laft, being under the neceffity of infpiring, and 
deeply, the pungent particles, imbibed in great quan- 
tity, and with confiderable force, will occafion fo con- 
siderable a degree of irritation, as will fuddenly and 
mofl effectually aroufe the patient from his ftate of 
infeniibility. 

To haflen the termination of the fit, as well as to 
prevent its return, the occafional or exciting caufc 
fhould be afcertained and carefully removed. 

But to prevent the recurrence of this difeafe, 
fomething more is required ; for too frequently fo 
flrong a difpofition to fainting fits exifls, that the 
mofl trifling circumflance may prove fufncient to 
occafion them. Whenever this is the cafe, there can- 
not be a doubt but that fo confiderable a degree of 
debility is induced, as will be likely to terminate in 

fome 



MEDICAL ADMONITIONS. $J$ 

ibme dangerous malady. The caufes by which this 
ftate of extreme debility may be produced 7 are fa 
numerous, and various, that to detect them, and ap- 
propriate the fitteft modes of cure, is a talk only to 
be undertaken by the fkilful and experienced. 



APPARENT DEATH. 



Reason and humanity demand, that a knowledge 
of the proper mode of treatment of perfons apparent- 
ly dead, from drowning, &c. or brought to the brink 
of the grave by famine, or exceflive cold, mould be 
as generally diffufed as poflible. 

The leading principle of our conduct, in every 
cafe where a near approach to death is occafioned by 
long failing, or expofure to extreme cold, is to yield as 
gradual a fupply as pojjible of thai stimulus, 
from the deprivation of which life appears to be about 
to ceafe. 

. Where life appears to be nearly extinguished by 
long expofure to extreme cold, the greatefl caution is 
neceffary in restoring the defective ftimulus heat. 
Its application fhould be at mil in the lowefl degree, 
and fhould be gradually increafed. Imitating the 
practice of the inhabitants of the cold countries, who, 
when any part of the body is frof -bitten, immediately 

thaw 



3)6 MEDICAL ADMONITIONS. 

thaw it, by rubbing it with fnow ; and very gradual* 
ly expofe it to the influence of a warmer temperature, 
well knowing, that by a fudden approach to the fire 
the frozen part would foon be entirely deftroyed. 

When from long faffing the vital powers feem to be 
nearly exhaufted, the fupply of the defective ftimulus, 
food, fhouid alio be made in the moft gradual and 
cautious manner. Weak broths fhouid be firft given, 
barely warm, and in very fmall quantities at a time ; 
and afterwards gruel, milk porridge, milk enriched by 
the addition of an egg, wine whey, &c. may confti- 
tute the nourilhment with which the reftoration may, 
by the gentiefl gradations, be completed. 

The directions given by the Royal Humane Society 
are fo clear and explicit, as to put it in the power of 
any one, to employ the moft powerful means for the 
recovery of the apparent dead. As no opportunity 
mould be omitted of promoting the diffufion of 
knowledge fo important to the deareft interefts of 
humanity, I have taken the liberty to introduce the 
procefs recommended by the fociety.* 

RESUSCITATIVE 

*The Editor of the Reports of this Society eloquently 
remarks — " What an exalted tranfport muft it afford every 
companionate breaft, to be inftrumental in recalling our 
helplels fellow-creatures from apparent death ; — to witnefs 
the heartfelt paflions of anguifh and defpatr, of hope, fur- 

prife; 



MEDICAL ADMONITIONS, 377 

RESUSCITATIVE PROCESS. 

What thou doeft, do quickly. 



THE DROWNED. 

i. Convey carefully the body, with the head raif- 
ed, to the neareft receiving houfe. 

2. Strip, dry the body 3 clean the mouth and 
noftrils. 

3. Young Children to be put between two perfons 
in a warm bed. 

4. An Adult — Lay the body on a bed, and in cold 
weather near the fire. 

In fummer, expofe the body to the rays of the fun 5 
and, in warm feafons, air mould be freely admitted. 

id 3 5. The body to be gently rubbed with flannel 
fprinkled with ipirits or flour of muflard. The 

Z z proper 

i 

prife, and joy, which alternately agitate the human frame ; — 
to mark the lively traits of gratitude, painted in the counte- 
nances of the mother, fitters, brothers, &c. of the reftored 
object !— What epicure could ever yet boaft fo refined, 
fo exquifite a luxury, as the benevolent deliverer from fuch 
a fcene — a fcene far beyond what any pen has yet been abl& 
to defcribe, or pencil to exprefs !" 



$>]$ MEDICAL ADMONITIONS. 

proper fubftances to be fprinkled on flannels, and a 
heated warming-pan, covered, may be lightly moved 
over the back and fpine — Salt never to be employed. 

6. The breafl to be fomented with hotfpirits. Hot 
bricks or tiles, covered, &c. to be applied to the foles 
of the feet and palms of the hands. 

If no figns of life appear, the body to be put into 
the warm bath. 

7. To rejlore breathing — Introduce the pipe of a 
bellows (when no apparatus is at hand) into one 
noftril ; the other, and the mouth, being clofed, 
inflate the lungs, till the breaft be a little raifed ; the 
mouth and noftrils mull then be let free. Repeat 
this procefs till life appears. 

8. Tobacco fmoke is to be thrown gently into the 
fundament, with a proper inftrument, or the bowl of 
a pipe covered, fo as to defend the mouth of the 
affiftant. - 

9. Eleclricity to be early employed, either by the 
medical afliftants, or other judicious practitioners. 

INTENSE COLD. 

Rub the body with /now, ice, or cold water. 

Reftore warmth by flow degrees ; and after fome 

time, if there be no appearance of life, the refufcitative 

procefs for the drowned mull be employed. 

suspension 



VlTIMOM'QA ,TA3K. 
MEDICAL ADMONITIONS. 379 

SUSPENSION BY THE CORD. 

i . A few ounces of blood may be taken from the 
jugular vein ; cupping-glaffes applied to the head and 
neck ; leeches alfo to the temples. 

2. The other methods of treatment the fame as 
recommended for the apparently drowned. 

SUFFOCATION EY NOXIOUS VAPOURS. 

Cold water to be repeatedly thrown upon the 
face, &c. drying the body by intervals. 

If the body feels cold, employ gradual warmth ; 
and the plans for reftoring the drowned. 

INTOXICATION. 

The body to be laid on a bed, with the head a little 
raifed : the neckcloth, &c. removed. 

Obtain immediately medical affijlance, as the modes 
of treatment muft be varied according to the circum- 
stances of the patient. 

GENERAL OBSERVATIONS. 

I « On Jtgns of returning life, a tea-fpoonful of 
warm water may be given ; and, if fwallowing be re- 
turned, warm wine, or diluted brandy. The patients 
muft be put into a warm bed ; and, if dilpofed to 
fleep^they will generally awake perfectly reftored. 

2. The 



380 MEDICAL ADMONITION!. 

2: The plans of refufcitation are to be ufed for 
three or four hours. 

Jt is an abjurd and vulgar opinion, to fuppofe perfons 
irrecoverable, becaufe life does not foon make its ap- 
pearance. 

3. Bleeding never to be employed } unlefs by the di~ 
retlion of the medical ajftftants, 



CONVULSIONS. 



By convulfions are here meant thofe epileptic con- 
vulfive fits, to which children are fubject ; and which 
from the fuddennefs with which they occur, and the 
fhocking appearances they exhibit, are truly fubjects 
of alarm to a parent. 

To prove how much circumfpection and fkill is 
required in the treatment of this difeafe, it may be 
only necefTary to point out the various caufes from 
which it may proceed. The difficulty which muft 
generally occur in afcertaining, on which of thefe 
caufes the convulfions may depend, mull be then 
fufficiently obvious. 

Among the moft frequent caufes of convulfions 
may be enumerated painful dentition ; the accefs of 
fmall pox, meafles, and other eruptive fevers ; the 

irritation 



MEDICAL ADMONITIONS. 38 1 

irritation from worms, in the inteftines ; exceflive 
diftenfion of the ftomach, with even food proper in 
quality ; the irritation from the employment of crude 
and indigeftible fubftances for food ; the retroceflion 
of eruptions on the ikin ; the incautioully drying up 
of fome difcharge \ the diftenfion of the ftomach or 
inteftines with wind - 9 fudden and violent noife; 
acute pain ; and breathing too long a vitiated air. 

Should it not be likely that medical advice can 
foon be obtained, as ftrict an enquiry as pomble 
fhould be made, by the parents of the child, to 
afcertain the exciting caufe ; fo that an appropriate 
method of treatment may be adopted. 

In the firft place, the ftate of the ftomach and 
belly mould be enquired into. If the region of the 
ftomach feems diftended ; if the child has, either 
before the fits, or in the intervals between them, made 
exertions to vomit -, and efpecially if the child has 
been fed plentifully not long before, an emetic of the 
tartarifated antimonial wine fhould be given as foon 
as it can be fwallowed, in a dofe proportioned to the 
age of the child. 

If there be an evident diftenfion of the belly ; 
efpecially if the child have appeared to fuffer pain in 
the bowels, the caufe of the mifchief may juftly be 
fufpected to exift there. Information muft then be 

obtained, 



382 MEDICAL ADMONITIONS. 

obtained, as to the previous flate of the child's bowels. 
When coftivenefs has preceded, a clyfler mould be 
exhibited, compofed of thin gruel, coarfe fugar, and 
caftor oil ; a powder may be alfo given, with a grain 
or two of calomel, and fix or eight grains of jallap ; 
repeating the clyfter every hour until ftools are ob- 
tained. But if the child have been reduced by a 
long continued loofenefs, the diftenfion of the bowels 
may be attributed to confined air -, and a clyfter, 
made by boiling carraway or annifeeds in thin gruel, 
fhould be directly given. A tea-fpoonful of fome 
carminative mixture, made by adding two tea-fpoon- 
fuls of fome aromatic cordial, fuch as annifeed, juniper, 
or carraway, with as many table-fpoonfuls of water, 
in which has been diflblved a fmall quantity of fugar, 
may be occasionally given. The belly mould be alfo 
rubbed with fuch a degree of preflure, as will be 
likely, without giving much pain to the child, to oc- 
cafion the difperfion of the confined air. Both in 
this, and in the laft cafe, the belly may be fomented 
with flannels wrung out of a ftrong decoction of 
camomile flowers. The camomile flowers themfelves, 
wetted with any fpirits, and made hot, may be alfo 
applied, in a flannel bag, to the belly. 

If the fymptoms which have previoufly occurred 
give reafon to fufpect the prefence of worms, a calo- 
mel purge may be given as foon as the child can 

fwallow j 



MEDICAL ADMONITIONS. |S| 

fwallow i and a clyfter may be thrown up, made by 
diffolving a few grains of aloes in water or milk, to 
which a fmall portion of oil may be added : the 
quantities, of courfe, depending on the age of the 
patient. 

In thofe fits, where the exciting caufe cannot be 
afcertained, and in the above-mentioned cafes, where 
fuch of the foregoing means as appeared moft appro- 
priate have not fucceeded, and regular affiftance can- 
not yet be obtained, the following meafures may be 
adopted. If the blood- veffels of the face be turgid, 
the eyes red, and the countenance of a crimfbn hue, 
blood may be taken away from the arm, or, by 
leeches, from the temples. The feet and legs may 
be bathed in warm water, and, where no confiderable 
determination to the head appears, fpirits of hart (horn, 
or fal volatile, may be held to the noftrils, and rub- 
bed on the temples, &c. 

Should the remedies employed prove fuccefsful, 
ftill confiderable attention will be required, in dis- 
covering on what caufe the difeafe depends, that the 
moft effectual: means may be adopted to prevent a 
relapfe. Here I mufl take notice of the abfurd 
opinion, that a phyfician is not required in the dif- 
eafes of children — an opinion which, unfortunately 
for the little fufferers, is too generally embraced. But 
furely the occurrence of circumftances/o ambiguous; 

as 



384 MEDICAL ADMONITIONS. 

as are perceived in the difeafes of children, demand 
the clofeft inveftigation, of even the mod intelligent 
phyfician. Often will, in other refpecls, a confiderate 
parent fay, " the poor child is unable to defcribe its 
complaints — therefore a phyfician can be of no ufe." 
Inftead of concluding, that in proportion as the cafe 
is involved in obfcurity, are knowledge and the power 
of difcernment required. Dr. Underwood, in his 
Treatife on the Difeafes of Children, juftly remarks, 
" that although infants can give no account of their 
complaints, in the manner we receive information 
from adults, their difeafes are all plainly and fufficient- 
]y marked by the countenance, the age, the manifeit 
fymptoms, and the faithful account given by the 
parent, or an intelligent nurfe. This I am fo confi- 
dent of, that I never feel more at my eafe, in prefcrib- 
ing for any diforders, than thofe of infants -, and never 
fucceed with more uniformity, or more agreeably to 
the opinion I may have adopted of the feat and the 
nature of the difeafe. Every diftemper may be faid, 
in fome fenfe, to have a language of its own, and it 
is the bufinefs of a phyfician to be acquainted with it ; 
nor do thofe of children fpeak lefs intelligibly. 
Limited as is human knowledge in every department, 
there are yet certain principles and great outlines, as 
well in phytic as in other fciences, with which men of 
experience are acquainted, that will generally lead 
them tafely between the dangerous extremes of doing 

too 



MEDICAL ADMONITIONS. $85 

too little, or two much ; and will carry them fuccefs- 
fully, where perfons who want thofe advantages cannot 
Venture to follow them. Let me afk, then, is it ob- 
fervation and long experience, that can qualify a 
perfon for the fuperintendance of infants, or the treat- 
ment of their complaints ? Surely all thef© fall 
eminently to the (hare of regular practitioners, to the 
Utter exclufion of nurfes and empirics." 



EPILEPSY, 

OR 

FALLING SICKNESS. 



In thefe fits, the perfon falls, fuddenly deprived of 
fenfe and motion. During the fit, the limbs, the 
mufcles of the face, and every part of the body, are 
violently agitated by convulfive ftruggles - 3 a frothy 
liquor iffues from the mouth, and, if great care be 
not taken, the tongue is thruft out of the mouth 
between the teeth, and wounded by their convulfive 
clofing. 

During the fit, the greatelt care mould be taken 
that the patient does not injure himfelf by the violence 
of his ftruggles : he therefore fhould be directly 
placed on a bed. From neglect of this caution, it 
often happens, that the poor Tufferer fuftains very 
A a a confiderable 



3S6 MEDICAL ADMONITIONS, 

confiderable injuries. The clothing (hould be ever/ 
where loofened, and the head moderately elevated. 
As foon as poflible, fome fubftance mould be intro- 
duced and held between the teeth to prevent their 
clofing on the tongue ; and even when fenfe appears 
to be a little returned, no vefTel of any fragile fub- 
ftance, as earthen -ware or glafs, mould be ufed for 
the purpofe of offering drink ; left, from the delirious 
ftate which occurs in the interval of the convulfion, 
or from the convulfion itfelf fuddenly coming on, 
he mould bite out a piece of the edge of the cup, or 
glafs, and thereby get the iharp and broken fragments 
within his mouth. 

Should it appear that the patient has been drinking 
too freely of fpirituous liquors, or has loaded his 
itomach with indigeftible and ofTenfive matters, the 
firft opportunity ihould be feized of getting a pretty 
ftrong emetic into the ftomach. In thefe cafes, it 
generally happens, that as foon as the ftomach is 
cleared of its injurious contents, the convulfions en- 
tirely luDiiae. 

With refpect to the other caufes of this fhocking 
difeafe, they are fo numerous, and, in general, fo 
difficult of detection, that the aid of fome medical 
man mould be always, if poflible, obtained immedi- 
ately on the fits taking place. To prevent the return 
of the fit, the domeftic pharmacopeia teems with re- 
cipes } 



MEDICAL ADMONITIONS, 387 

opes ; but, previous to the adoption of any of t:hefe, 
$muft entreat you, and my other readers, to attend 
to this fad — That this difeafe may arife from caufes 
almofl innumerable ; and many of thefe not only 
much differing from, but even fometimes directly 
oppofite to, each other. A due attention to this 
circumftance muft certainly, not only fhew that a 
medicine ought not to be thus matched at random ; 
but alfo that much patient inveftigation will be re- 
quired to be employed, even by the moil intelligent 
phyfician, before he can venture to determine on the 
means to be ufed for the cure. 

====================== 

WORMS. 

sol z&d 'lO <E\ . 

As epileptic or convulfive fits are very frequently 
occafioned by the prefence of worms in the inteflines, 
it may not be improper to fpeak of them here. 

Palenefs, irregular appetite, and pains of the flomach 
and bowels, are generally fuppofed to be marks, by 
which the exiftence of worms in the flomach or 
bowels may be known ; but thefe fymptoms are 
equivocal, fince they generally accompany a debili- 
tated ftate of the fyftem, proceeding from any caufe 
whatever. Indeed, it is by no means fo eafy, as^yi 
general imagined, to determine whether worms 4p 
. gcvai-v really 



388 MEDICAL ADMONITIONS. 

really exift in the bowels, or not. It would be eafy 
to recite, in this place, the figns which are ufually 
faid to denote the prefence of worms ; moft, or indeed 
all, of which accompany debility arifing from various 
other caufes : but the point is only to be determined, 
by a judicious and careful confideration of all the 
fymptoms that are prefent, as well as of former illneffes, 
on which fome of thefe fymptoms may depend. 

The neceffity of determining, with fome degree of 
accuracy, whether the complaints of a child depend 
on worms, or not, is much greater than may at firft 
appear. The fymptoms which are faid to mark their 
prefence, I have already obferved, are thofe which 
like wife accompany debility from any other caufe. 
If, therefore, this debility proceed not from worms, 
and the means generally recommended for their re- 
moval, particularly fmart mercurial and fcammoniate 
purges, be adopted, they will not only fail of produc- 
ing beneficial effects ; but, by increafing the weaknefs 
of the patient, occafion very dangerous confequences. 

Within thefe few months, I witnefled the defiruc- 
tion of a young woman, who, enfeebled by a weak 
ftate of the ftomach and bowels, could not be diffuad- 
ed from believing that her complaints were occahoned 
by worms. She therefore procured and took, without 
acquainting her friends, a noflrum advertifed ns a fafe 
and Ipeedy cure for worms. After a little time, fhe 

perceived 



MEDICAI. ADMONITIONS. 389 

perceived a little forenefs of her mouth : this fhe 
little noticed. It became worfe, and this (he con- 
cealed as long as ihe could, afhamed of having 
fecretly employed thofe means to which fhe attributed 
her prefent complaints. At lafl fhe informed her 
friends of her diflrefs and its caufe, and, upon exami- 
nation was now found to be in a deep falivatiori. 
By a proper treatment the falivation was, after fome 
time, flopped j but fo much was fhe reduced by the 
feverity of her fufferings, by the quantity of faliva 
dif charged, by the deprivation of her food, &c. that, 
although placed in the country, under the care of an 
attentive and afliduous mother, fhe foon died, 



.. 



WEAKNESS OF THE STOMACH. 

The fymptoms which evince a weak date of the 
flomach are lofs of appetite ; fqueamimnefs, fome- 
times arifing to fuch a degree, as to be fucceeded by 
vomiting ; heart-burn ; coflivenefs ; diflenfions of 
flomach, particularly upon taking even a very fmall 
quantity of food ; frequent rifings into the throat of 
a fharp acid liquor 5 and eructations of imperfectly 
digefled matter. 

The evils arifing from this difeafe, are by no means 
confined to the flomach ; but generally extend over 

the 



390 MEDICAL ADMONITIONS. 

the whole fyftem. From the fympathy which exifts 
between the brain and the ftomach, the patient is 
alfo affected with giddinefs, and pain of the head. 

In confequence of the functions of the ftomach not 
being duly performed, a fufficient quantity of aliment 
is not taken into the ftomach j and what little is 
taken in, does not undergo a proper digeftion. The 
blood, therefore, becomes foimpoverifhed, that the 
body no longer receives its due quantity of nourifh- 
ment ; hence arifes a palenefs and coldnefs of the 
whole furface of the body, and particularly of the 
extremities ; the patient becoming weak and emaci- 
ated, his lips white, his tongue foul, and his counte- 
nance bloated and unhealthy. A confiderable degree 
of languor and dejection of fpirits alfo take place, his 
nights are difturbed with frightful dreams ; and in 
the day time his mind is diftrerTed with a variety of 
ill-grounded alarms, and apprehenfions. If the dif- 
eafe is not timely oppofed by proper means, the feet 
and legs will be perceived to fwell ; plainly (hewing 
that excefiive debility has taken place, and that a 
collection of water may be foon formed in fome of 
the larger cavities, by which death itfelf may be in- 
duced. 

Errors, and irregularities in the mode of living, are 
the moft frequent caufes of this malady. Thofe who 
indulge in the immoderate ufe of tea and coffee, are 

particularly 



MEDICAL ADMQNITX0N3, ££* 

particularly liable to it ; as well as thofe who ar^ 
habituated to the conflant ufe of tobacco, and opium. 
Even bark and bitters, than which few things are 
more ferviceable in curing this complaint, will fre- 
quently increafe it, or even produce it, if exhibited 
improperly. Thofe who are much expofed to cold 
and moifl air, and thofe who lead fedentary lives, and 
apply themfelves too clofely to bufinefs, or to intenfe 
fludy, as well as thofe who fuffer from anxiety, and 
diftrefs of mind, are often victims to this difeafe. 
Diftending the ftomach frequently, with excefHve 
quantities of either folid or fluid aliment, is likewife 
injurious. But the moil frequent caufe of weaknefs 
of the ftomach is, perhaps, the conflant ufe of fpiritu- 
ous and flrong fermented liquors. Nor is it neceflary 
to the production of this difeafe, that thefe liquors 
fhould be taken in fuch quantities as will produce 
intoxication ; fince thefe effects fucceed to the fre- 
quent drinking of them, in fmall quantities, and even 
when highly diluted. 

i 
There are few difeafes, if any, over which the phy^ 
fician has fo little power ; unlefs aided by the refolute 
efforts of the patient, as in this. In vain may he 
prefcribe the beft adapted remedies, and in vain may 
they be fwallowed, unlefs the ftricteft attention be 
paid to thofe rules, which every phy fician mufl think 
neceffary to deliver to patients in this difeafe. Thefe 

injunctions, 



J$$ MEDICAL ADMONITIONS. 

injunctions, indeed, mud too frequently be of fuch A 
kind, as very few will be difpofed to fubmit to ; fince 
they will enjoin, perhaps, the yielding up of habits, 
which, in confequence of long indulgence, have taken 
fuch poffeffion of the will, as to require the moft 
fedulous, and unremitting endeavours to overcome 
them. They may perhajps require a courfe of life to 
be purfued, totally oppofite to that in which the 
patient has placed his greateft delight and enjoyment. 

There exifls but little chance that a phyfician wiil 
be able to convince his patient, that any ill effects 
can be produced by the continuance of practices, in 
which he has fo long perfevered - 3 and in which fa 
many perfifc, and, as he fuppofes, for want of fuffici- 
ent enquiry, with entire impunity. Or fnould a 
phyfician prove fo fuccefsful, with the arguments he 
may adept, as to convince his patient of the peini- 1 
cious confequences of any farther indulgence ; how 
little probability is there, that the neceflary reflric- 
tions will be complied with. Rather will it happen, 
and, in fact , fo it daily does happen ; that the patient, 
foured by the long continuance of his difeafe ; angry 
with the phyfician, for having pointed him out, as 
the caufe of his own fufferings ; and vexed with him- 
felf, for his weaknefs, and want of refolution ; will 
rail at the inefBcacy of the art, and perhaps at the 
ignorance of its profefTors , afferting, that the admo- 
nitions 



Medical admonitions. 393 

nitions he has received, are fuch leflbns of aufterity, 
as his monitor himfelf, has neither the power, nor the 
inclination to follow. 

If a phyfician takes upon himfelf the honelt part 
of mewing to his patients* that the greateft number 
of difeafes are the refult of indulgence in indolence 
and luxuries, he may expect, to a certainty, the fate 
of having his lectures but little attended to ; and 
may even efleem himfelf fortunate, if he efcape both 
abufe and ridicule, " Who is this,'* the multitude 
cries, " who prefumes thus to preach ? 'Tis fome 
" fatiated epicure, or fome rigid melancholic. It 
* c health and life are only to be pilrchafed at the price 
" of all our enjoyments, they are not worth the price. 
" If our lives are thus to confifl of a perpetual ftate 
<s of warfare and toil, hourly ftruggling between the 
* £ dictates of our habits and inclinations, and the 
" denunciations of our phylicians, let us take our 
" chance — A fhort life and a merry one." Were 
phj'ficians to expect, that the prefent race of bon vi- 
vants would be reformed by their writings, and would 
immediately fet about to correct their irregularities, 
and abridge themfelves of their* indulgences, they 
might perhaps deferve to be told, that their plan was 
chimerical and abfurd. But thofe who venture to 
inveigh againft idlenefs and intemperance, prefume 
not to hope for the accomplifhment of fuch wonders - 9 
B b b they 



394 MEDICAL ADMONITION*. 

they cannot expect that their doctrine fhould oftes 
procure the facrifice of favourite, and long indulged 
habits : they will be amply rewarded, with the pleaf- 
ing idea of having made fome converts, to their 
opinions ; who, though they may not poffefs resolu- 
tion enough to quit the paths in which they have fo 
long trodden, will not be inclined to fuffer their 
children to be enflaved by habits, the ill effects of 
which they have themfelves fo much experienced. 

This difeafe, however, as you will perceive by re- 
verting to the enumeration of its caufes, is not the 
lot only of the luxurious liver 3 fince it too often 
forms an addition to the diftrefTes of the unfortunate ; 
but never more certainly, than when he feeks a 
refpite from his miferies, in the temporary exhilara- 
tion arifing from the abufe of fpirituous liquors. 

The fymptoms accompanying this malady, mark 
it fo distinctly, that there are very few who fuffer from 
it, but are enabled to judge of the nature of their 
complaint. The inconveniences they experience 
evidently pointing out a . weakened ftate of the 
flomach. 

When the fymptoms have become fo considerable 
as to force the patient to feek for relief, he in general 
has recourfe to fome heating aromatics, or bitters 
fteeped in fpirits : the ftomach being Stimulated by 

thefc 



MEDICAL ADMONITIONS. 395 

thefe means, a trifling amendment will take place ; 
fome of the fymptoms becoming more moderate, 
whilft others are even fufpended. This truce will be, 
however, but of very fhort duration, unlefs more 
effectual means be employed. To procure an entire 
removal of the difeafe, the ftomach muft be cleanfed 
of the fordid and ill digefted matters with which it is 
loaded ; and proper regulations muft be adopted, both 
as to diet and medicine, to prevent their future accu- 
mulation. If thefe be carefully attended to, the 
Peruvian bark, bitters, preparations of fteel, &c. may 
be adminiftered with great probability of efTential 

benefit. 

sibb& flfi e/rnol 
The infufion of camomile flowers is a medicine 
which is frequently employed, with a considerable 
degree of fuccefs, in this difeafe j but owing to a 
miftake, fometimes made in the mode of adminifter- 
ing it, effects are produced, quite oppofite to thofe 
which were hoped for : the error confifls in the in* 
fufion being drank warm, and in a large quantity ; 
by which naufea, and even vomiting, is produced ; 
whereas if taken in the quantity of a tea-cupful, and 
quite cold, it lefTens fkknefs, and increafes the 



:3odaoD ol smoDsc nodYf' 

I To furnifh a plan of regimen, adapted to every 
confutation and habit, is by no means aa-eafy.-tafk;'; 
fince fome variation will be always required, according 
ateril to 



396 MEDICAL ADMONITIONS. 

to the age and ftrength, as well as the former habits 
of the patient. But, in general, by fiddly regarding 
the following rules, the cure of the difeafe will be ac- 
celerated, and future attacks of it prevented. 

The greateft attention fhould be exerted by the 
patient, in endeavouring to dilcover what circum- 
flances prove beneficial, and what injurious , regulat- 
ing his mode of living, in future, by the information 
he thus obtains, The circumftances which have 
been already enumerated, as productive of this difeafe, 
muft, of courfe, be carefully avoided. 

The food fhould be taken in fmall quantities at a 
time, but with frequency ; carefully avoiding the dif- 
tendir g of the flomach, efpecially with liquids. Fat 
of meat, butter, and all oily fubftances, fhould be 
taken very fparingly ; and if at all rancid, abftained 
from entirely. Broths, &c. with all liquid food, 
(hould be fully impregnated with nutritive matter ; 
and fhould be taken only lukewarm. Fruits, and 
vegetables of all kinds, fhould not be ufed, until a 
confiderabie progrefs is made in the cure. The vege- 
table acids, fuch as vinegar, lemon-juice, &c. fhould 
be employed with a confiderabie degree of caution. 

Early rifing, and moderate exercife in the air, par- 
ticularly riding on horfeback, will prove exceedingly 
ferviceable, giving ftrength and tone to the flomach, 

as well as to the whole fyftem. 

But 



MEDICAL ADMONITIONS. 397 

But when it is considered, that this difeafe may, if 
pot timely removed, produce hypochondriacal, and 
other moft ferious and diftrefling complaints, no one, 
furely, who has it in his power, will hefitate, as to 
obtaining the advice of the intelligent and friendly 
phyfician. 

nohi 

HYPOCHONDRIAC AFFECTION, 



The hypochondriac is diftinguifhed, in the words 
of the celebrated Cullen, by — A languor, liftleffhefs, 
and want of refolution and activity with refpeft to all 
undertakings 5 a difpofition to ferioufnefs, fadnefs, 
and timidity ; as to all future events, an apprehenfion 
of the wOrft, or moft unhappy ftate of them ; and 
therefore, often upon flight grounds, an apprehenfion 
of great evil. Such perfons are particularly attentive 
to the ftate of their own health, to every the fmalleft 
change of feeling in their bodies ; and from any un- 
ufual feeling, perhaps of the flighteft kind, they appre- 
hend great danger, and even death itfelf, 

Thofe who are unhappily afflicted by this malady, 
too frequently become the fubjefls of raillery and 
reproof. The ftrange capricioufnefs of their com- 
plaints induce thofe around them to fufpedt them all 
to be imaginary. This is, however, very far from 

being 



g9$ MEDICAL ADMONITIONS.' 

being the cafe. It is true, indeed, that from the con- 
stant attention they are difpofed to pay to every 
trifling change which arifcs in their bodies, and from 
the appreheniions with which they are tormented, 
their account of their feelings may be rather exagge- 
rated and hyperbolical. But allowing this to be the 
fact, and even that the moft ridiculous and chimerical 
diftreffes are imagined by them j even in that cafe, 
their fufferings are fuch, that no confiderate perfon 
will regard them in any other point of view, than as 
demanding all the iolace and relief that friendfhip, 
attention, and judgment, can bellow. 

It muft be conferTed, indeed, that much depends 
on the patient himfelf, and that feveral circumftances 
imperiously require of him a confiderable degree of 
exertion. A fondnefs for frequent and various 
medicines, he fhould carefully ftrive to reprefs ; he 
mould feek for a phyfician to whom he can entruft 
himfelf and his complaints, with friendly confidence, 
and to whofe advice he can pay implicit obedience ; 
guarding himfelf againfb fufpecting neglect, becaufe 
his medical friend honeltly avoids to load his ftomach 
with more drugs than are necelTary. But the grand 
point, on which all muft turn, is his ready acquiefcence 
in thofe other meafures which may be dictated 
to him, as elfential to his recovery. He muft 
aroufe himfelf from his diftreffing ftate of liftlefmefs, 

and 



MEDICAL ADMONITIONS. JQ^ 

and allow himfelf to be difpofed of as his friends may 
advife, for the purpofe of diverting his attention to 
other objects than his own feelings. His propee 
avocations fhould be attended to, fuch arrangements 
being formed, as mail prevent him from being expofed 
to too much anxiety or fatigue. 

His amufements mould always be fuch as will af- 
ford a fufflcient degree of intereft ; fuch are games 
of ikill, as cards, draughts, backgammon, and evert 
chefs ;. for although the latter demands almoft pain- 
ful attention, yet it thereby prevents a much more 
injurious attention to certain other obje&s. Thefe 
fedentary amufements mould not wholly engrofs his 
hours, but mould be interrupted by various exercifes 
in the open air - 3 fuch as failing, riding on horfeback,, 
driving a carriage, &c. 

I cannot quit this fubjec"t without again noticing 
the folly, nay cruelty, of considering- this complaint 
as dependent on the will of the fufferer ; and remark- 
ing, that fo far from this being the cafe, this difeafe 
particularly depends on the original temperament of 
body. As well, therefore, may the peculiar make of 
the patient be afcribed to him as a crime, as the dif- 
treffing feelings he experiences be attributed to his 

•-■\rf -vprrt fitodj fit 

caprice. 

ftum >H *Yi3V0D3i COLIC, 

mfl grull 



4.00 MEDICAL ADMONITIONS. 

COLIC. 

To the treatment of this malady, domeflic do&ref- 
fes have long laid an exclusive claim : family phar- 
macopoeias teeming with colic tinctures and elixirs, 
which, except when compofed of too fiery ingredients, 
will frequently produce a mitigation of the fymptoms, 
and fometimes a cure; 

To produce this defirable effect, however, thefe 

medicines mud be employed in pure colic ; and where 

no inflammation of the inteftine has taken place. 

But, unhappily, it is extremely difficult to determine, 

whether inflammation be come on, or not : and there 

is very little doubt, that if this mould be the cafe at 

the time of the administration of thefe medicines, con- 

fiderable injury may be occafioned. Dr. Alexander 

Monro obferves, " The common practice of taking 

fpirituous liquors, or the warm carminatives, when 

people feel colic pains, is often unlucky, and public 

warning fhould be given againft it ; for though relief 

is found from fuch things in the windy or fpaf "odic 

colic, which is not a deadly difeafe ; yet they hurry 

on the inflammatory diieafes io fait, that they foon 

prove mortal." * 

Much 

* Observations, &c. by Dr. A. Monro. Medical and 
Literary Eilays, Vol. I. 



MEDICAL ADMONITIONS. 40 1 

Much mifchief may indeed be the confequence ot 
niiftaking the fymptoms of pure inflammation of the 
bowels, or of ilrangulated rupture, for thofe of colic. 
It is not to be wondered at, that domeftic practition- 
ers (hould be very liable to fall into this error ; fince 
confiderable attention is required in the exercife of 
the judgment, in fimilar cafes, by thofe who are well 
ikilled in the nature of thefe difeafes. This arifes 
from the fimilarity of the fymptoms belonging to 
thefe feveral difeafes. 

In colic, the chief fymptoms are, frequent vomit- 
ings, obftinate coftivenefs, fevere griping pains over 
the whole of the belly, but chiefly about the navel, 
accompanied by a painful fenfation of diftenfion j the 
external part 6f the belly being, at the fame time, 
drawn irregularly inwards. If thefe fymptoms be 
compared with thofe which were defcribed as the 
fymptoms of inflammation of the bowels, and with, 
thofe which belong to ftrangulated rupture, treated 
of in the next article, the refemblance will be found 
to be fo great, as plainly to mew the danger of at- 
tempting even the alleviation of fuch fymptoms, 
without judgment fufScient to difcover their true 
origin. 

In thofe cafes where other affiftance cannot be ob- 
tained, and where, from the former occurrence of the 
fymptoms, or from other circumftances, the difeafe is 
C c c clearly 



402 MEDICAL ADMONITIONS. 

clearly afcertained to be colic, a clyfter may be given, 
compofed of a pint of warm fat broth, to which may 
be added a table-fpconful of common fait ; or the 
fame quantity of gruel with two table-fpoonfuls of 
caftor oil, and a table-fpoonful of feft fugar. If (tools 
are not thereby obtained, a lpoonful or two of caftor 
oil may be taken. The belly mould be fomented 
with flannels wrung out of hot water, and between 
the times of fomenting may be covered with one of 
the flannels wrung out as dry as poflible, over which 
may be laid a large oxes bladder, nearly filled with 
hot water. 

If thefe means fail, much circumfpecrion is re- 
quired, before any determination is made, as to the 
next meafure to be adopted ; it being neceflary to 
afcertain, with as much precifion as poflible, whether 
inflammation has taken place or nor. For mould 
the complaint be merely colic, without inflammation, 
the cure may be accomplished by fome carminative 
purging remedy, fuch as fena tea, warmed by the 
addition of a little fpirits of annifeed ; but fhould 
inflammation have come on, not only will every thing 
irritating be productive of farther injury, but it will 
even be neceflary to employ bleeding, and that with 
a confide rable degree of freedom, 

RUPTURES, 



MEDICAL ADMONITIONS. 403 

RUPTURES, OR HERNLE. 

The term rupture was adopted when it was fup- 
pofed, that the difeafe was always the confequence of 
a rupture of fome of the parts which form the cavity 
of the abdomen or belly. But anatomical examina- 
tion has fhewn, that this difeafe, as it moil commonly 
appears, takes place in confequence of the protrufion 
of fome of the contents of the abdomen, through 
openings which are natural to the human body ; and 
without any rupture, or violent feparation of parts. 
It will not be neceffary to defcribe particularly, the 
feveral kinds of ruptures which may occur. It will 
be fufficient to obferve, that ruptures generally appear 
in the groin, in the upper and fore part of the thigh, 
and at the navel : but they alfo may occur in any 
point of the fore part of the belly. Thofe which ap- 
pear, at firft, juft above the groin, will, in general, if 
neglected, foon defcend into the fcrotum, in men, and 
into the labia pudendi, of women. The tumor, in 
this difeafe, is mcft commonly formed by a part of 
the inteftinal canal, or of the omentum or caul, or 
of both. 

In thofe ruptures which are capable of eaiy re- 
duction, as foon as preffure is properly made, the 
protruded interline generally flips up, all at once, 
with a kind of guggling rioife. and the tumour imme- 
diately 



404 MEDICAL ADMONITTOKS. 

diately fubfides : where the tumour has chiefly been 
formed by omentum, that paffes up more ilowly, and 
without that particular noiie which accompanies the 
return of the interline. 

In thofe cafes of rupture, where ftricture has taken 
place en the protruded parts, and the reduction is 
thereby rendered difficult, the belly becomes tenfe 
and painful, the pain of the belly, as well as of the 
tumour itfelf, being much increafed by the leaft ex- 
ertion ; a total ltoppage ot difcharge by iiool takes 
place, and the patient is diftreffed by a ficknefs at the 
ftomach, which increafes, until almofl conflant retch- 
ings add to his fufferings-. 

Having called your attention to thefe two ftates of 
ruptures, with or without ftriclure, I will now point 
out that information refpecting them, of which I am 
convinced that every one ought to be poiTeffed. 

In thofe ruptures which are eafily reduced, the 
mind of the patient mould be imprelTed with the 
conviction, that, in general, and particularly where 
the difeafe is recent, it will depend entirely on his own 
choice and refolution, whether he ever fuffer from it 
any ferious inconvenience, or not. He may affure 
himfelf, that from the moment the parts are reduced, 
he has it in his power conftantly to retain them in 
their natural fituation ; and that, if he neglects to do 

this. 



MEDICAL ADMONITIONS. 403 

this, he may expect the difeafe to increafe daily ; 
and, not only that the tumour may attain an incon- 
venient, and even enormous fize, but that he will be 
alfo momentarily liable to have a ftri&ure induced on 
the protruded parts, which never happens without 
the greateft degree of danger, 

To prevent all thefe evils, it is only neceffary, that 
fuch a preffure be kept on the opening, through 
which the part protruded, as may prevent its again 
falling out : the preffure of the fingers (hews how 
effectually this may be done, and if, at the time this 
preffure is made, the patient but gently coughs, he 
will difcover how forcibly the protruding parts are 
driven outwards, and how neceffary it is to guard 
againft their future propuliion. The ingenuity of 
artifts has devifed a mode, by fpring truffes, of apply- 
ing a conflant and properly adapted preffure - ? requir- 
ing little or no exertion, or even attention, of the 
patient himfelf. No perfon, therefore, in the fitua- 
tion thus defcribed, iliould fuffer a day, more than is 
abfolutely unavoidable, to pafs, without obtaining 
the comfort and fecurity which will follow the appli- 
cation of a trufs ; lince, if it be adopted at the firft 
appearance of the difeafe, not only will the malady be 
flopped in its progrefs ; but, if employed with con- 
flancy and fteadinefs, a radical cure may be gained. 
To thofe whofe circumftances will render the acquisi- 
tion 



406 MEDICAL ADMONITIONS. 

tion of this inftrument eafy, nothing further need be 
faid ; but the poor induftrious labourer, whofe 
month's earnings would hardly fuffice to make the 
required purchafe, fhouid be apprifed of the vaft im- 
portance of the early application of a trufs : his better 
informed neighbour fhouid inftruct him, that after 
the firft appearance of this difeafe, no confideration 
ought to induce him to make one more laborious ex- 
ertion, until provided with this fecurity againft future 
mifchief ; — that, if neglected, it will, in confequence 
of his exertions, increafe with rapidity ; and may even 
foon deftroy him : and laftly, that there can be no 
little luxury, or convenience, which he ought not to 
give up ; nor any facrifice of delicacy, which he 
ought not to make, that prevents his application for 
benevolent and charitable aid, in procuring this im- 
portant and neceffary inftrument.* 

If 

* It is with much pleafure I perceive an inflitution is 
formed, under the chirurgical direction of Mr. W. Turnbull, 
for fupplying the ruptured poor with trufles. It is much 
to be wifhed, that fimilar charitable eftablifhments may be 
formed in every part of the kingdom, for the relief of the 
poor afflicted with this malady. Miferable indeed is the 
ftate of him, who is under the neceffity, either, for the fake 
of retarding the progrefs of this diforder, of totally abftain- 
ing from the lahour which fumifhes his family with bread ; 
or of rapidly increafing this (hocking evil, and even of hasten- 
ing his death, by perfevering in his employments. His 

claims 



MEDICAL ADMONITIONS. 4O7 

If it be difcovered that the return of the rupture is 
become difficult, and that a ftriclure on the protruded 
part has perhaps taken place, the perfon fhould place 
himfelf on his back, inclining to the fide oppofite to 
that difeafed, with the head low, and the breech raif- 
ed high, the knees being drawn upwards, and a little 
outwards. Whild laying in this pofture, he mould 
endeayour, by fuch preflure as he has been accuftomed 
to employ for its redu&ion, to return the protruded 
part. Should he not fucceed in this attempt, he may 
lay on the part a piece of folded linen dipped in cold 
water, and repeat his attempts. If theie be alio un- 
fuccefsful, he may then be allured that a ftridure has 
taken place, and that on the speedy removal 

OF THIS HIS LIFE DEPENDS. 

This affertion is by no means made to occafion 
unneceflary alarm. One moment's consideration of 
the flate of the parts, muft be fufficient to (hew the 

neceffity 

claims on the affluent are furely too juft and powerful to be 
evaded ; efpecially by thofe who have themfelves experien- 
ced the great advantages derivable from the ufe of thefe in- 
ftruments. Mr. Blizard, in his Suggeftions for the Improve- 
ment of 'Hofpitahf &c. when enumerating the cafes of diftrefs 
in hofpitals, which call upon humanity forconfideration, but 
which cannot be brought within the provifions of thofe 
valuable inltitutions, particularly mentions " Cafes of rup- 
ture, from fudden catifes, which frequently require trulTes, 
for preventing relapfe, and even confequent death." 



403 MEDICAL ADMONITIONS, 

neceffity of immediate regular aid, and the danger of 
trufting to domeftic tamperings. Let it then be 
confidered, th?it part of the contents of the abdomen, 
and probably a fold of the inteftine, is thruft out of 
the cavity, and confined by the clofe preflure of the 
fides of the aperture, through which it has paffed ; 
that whiiit in this flatc no faxes can poflibly pais be- 
yond the protruded part, a circumftance which of 
itfelf mult occafion death ; that, almoft from the 
moment of its being thus incarcerated, inflammation 
begins to take place j and proceeds, if the ftricture 
be not removed, until it terminates in mortification ; 
and that the mod expert and judicious furgeons are 
fometimes unable to reduce the protruded part, with- 
out an operation. Surely, when thefe circumflances 
are confidered, no one will hefitate in determining, 
that not a moment fhculd be loft ; but that the bed 
chirurgical affiftance that can be had, mould be di* 
redly obtained. 

From want of knowledge of thefe circumflances, 

alarm is, in general, not excited diffidently foon to 

allow of benefit being derived, even from the beft 

adapted means - 3 and very frequently, as is known 

to almoft every furgeon, in that time which is loft, in 

following the routine defer ibed in fome treatife on do- 

medic medicine, do thofe mifchiefs occur, which 

place the recovery of the patient beyond the reach 

of art. 

But 



MEDICAL ADMONITIONS* 409 

But it is not the lofs of time merely, of wrhich we 
have here to complain ; fince it muft too often hap- 
pen, that the attempts to reduce the rupture, made 
by one who is not porTefled of any anatomical know- 
ledge, muft increafe the difficulty of the reduction. 
Force, in moll cafes, muft be employed ; but if this 
be not done moft carefully, and in a proper mode and 
direction, no advantage will be derived from it ; but, 
on the contrary, the fold of the interline, which, in 
confequence of the ftricture, is already conliderably 
inflamed, will fuffer an increafe of inflammation, and 
the total ftrangulation of its veflels, and the death of 
the patient, muft be accelerated. 

Should every other means have been employed 
without fuccefs, the reduction of the rupture, by 
operation, mould be had recourfe to. By this the 
furgeon obtains accefs to the protruded part, and is 
then enabled, not only to adopt effectual means for 
its reduction, but even for a radical cure. The 
horror excited by the idea of fuch an operation, as 
mall expofe a part of the inteftinal canal, frequently 
determines the patient to fubmit to the certain lofs 
of life, rather than thus receive immediate relief. His 
terrified imagination conceives the operation to be 
painful and dangerous in the higheft degree. His 
alarm prevents him from fairly attending to the argu- 
ments employed to induce him to fubmit ; and he 
D d d concludes, 



410 MEDICAL ADMONITIONS. 

concludes, that the chance of relief is fo little, as not 
to be worth the additional torments, he imagines he 
lhall fuffer from the operation. But every man's 
mind mould be impreifed,. previous to the moment 
of alarm and confuilon, with thefe important truths — 
that the pain of this operation but little exceeds that 
which the patient is already fuffering, or that which 
would be experienced by opening a moderate fized 
abfcefs ; and that fo little danger attends the opera- 
tion itfelf, that in almolt every cafe where it terminates 
fatally, it may be fairly attributed to its having been 
too long deferred. 

Before I conclude this article, juftice to the afflict- 
ed demands, that I mould fhte the claims a patient 
has on his furgeon, in this cafe. When once a ftric- 
ture has taken place, no temporifing can be admitted ; 
nor ought the patient to be left, a moment, with the 
fallacious hopes of a cure, by the fpontaneous efforts 
of nature : inftances of relief having thus occurred 
are too rarely met with to be allowed to influence our 
practice. Firmnefs, perfeverance, and decifion, muft 
mark the conduct of the furgeon -, not a fingle mea- 
fure that can be adopted with fafety, and that affords 
the leafl hope of preventing the operation, fhould be 
omitted ; but when thefe have failed, the operation 
fhould be performed, without a moment's longer 
delay. 

RUPTURE 



MEDICAL ADMONITIONS. 411 

RUPTURE AT THE NAVEL IN 
CHILDREN. 

This is a complaint of very common occurrence, 
and but feldom excites that attention and intereft 
which it has a right to demand. Mothers obferve a 
flight protrufion at the navels of children, and witnefs 
its very gradual increafe without alarm. They mould 
therefore be informed, that if proper means for its 
cure be not adopted, it may become of a moft enor- 
mous fize, and even occafion the lofs of life. To 
this information it is moll pleafing to add, that the 
means of cure are in every one's reach ; and will be 
almoft always fuccefsful, if employed early, and at- 
tended to conftantly. 

The means to be adopted are fimply thefe — The 
protruded parts are to be returned, which may be 
eafily done by flight preflure with the finger ; and 
retained in their proper fituation, by a conical piece 
of very foft fponge, thoroughly cleared, by rubbing 
between the thumb and finger, of fand and minute 
fhells, which may be lodged in its cavities. This 
being kept to the part, by the point of one finger, is 
to be fecured by feveral flips of flrongly adhefive 
plaifter, three inches in length, crofling each other in 
a ftellated form. 

It 



412 MEDICAL ADMONITIONS. 

It is proper, however, again to enforce the necefiity 
of a conftant attention in this cafe. It is not by 
keeping the parts confined for a few days, and then 
permitting them to remain unreftrained for a day or 
two, before the means are again employed, that a cure 
can be expected. Real advantage can only be ob- 
tained by conftant and uniform preflure. Should, 
therefore, any difficulty arife in this very necefTary 
procefs, application mould immediately be made to 
thole who are in the habit of performing this and 
fimilar operations. 

The difficulty of retaining the parts in their natural 
fituation may indeed be produced, by the nature and 
extent of the protrufion, and the advice of a furgeon 
may therefore be necefTary to determine whether it 
will be fafe to depend on this mode, or whether it will 
not be required to employ a well adapted elaflic trufs. 



ULCERATION OF THE NAVEL IN 
CHILDREN. 



A soreness of the navel fometimes occurs in 
newly bcrn children, fome weeks after the navel has 
appeared to be healed - s which feldom heals, even 
under proper treatment, in lefs than five or fix weeks. 

Bat parents fhould be apprifed, that an ulceration 

of 



MEDICAL APMONITIONS. 413 

of this part, much more dangerous and ungovernable, 
jbmetimes takes place, in children where a conlidera- 
bte degree of debility is manifeft. In thefe cafes, if 
the moft effectual means are not early employed, the 
child will moft probably be loft ; and, indeed, in 
many cafes witnefled by Dr. Underwood, in which, 
of courfe, all that fcience could fuggeft was adopted, 
the ulceration fpread over a great part of the belly, 
and even mortification enfued. 



CHOLERA. 



In the difeafe thus named, the patient is harralTed 
by almoft conftant vomiting and purging - 3 bile ap- 
pearing to exift in a considerable proportion, in the 
matters thus difcharged. In general, the patient is 
alfo diftreffed with fevere griping pains of the bowels, 
fpafmodic contractions of the mufcles of the belly, 
and extremely painful cramps in the mufcles of the 
extremities. 

In thofe cafes where the difeafe is only in a mode- 
rate degree, where the patient is ftrong, and of a 
middle age, and no very considerable diminution of 
his ftrength takes place, there exifts little or no 
danger. The free ufe of diluting drinks, as gruel, 
broths, &c. will, in general, prove fumcient to procure 

the return of health. 

But 



414 MEDICAL ADMONITIONS. 

But when the difeafe comes on with great violence ; 
occafioning faintings, cold fweats, coldnefs of the ex- 
tremities, and a fudden exhauftion of ftrength, the 
patient may be concluded to be in a mod perilous 
fcate : life depending on the immediate adoption of 
the mod vigorous meafures. Young children, per- 
fons advanced in years, and thofe who have been re- 
duced by preceding difeafes, muft be attended to 
with the utmoft care and vigilance - 3 fince, in the 
courfe of two or three hours, the difeafe, if unreftrain- 
ed, may fink them fo low, as hardly to leave a poffi- 
bility of their recovery. When marks of leffening 
ftrength are evident, the moft flrenuous exertions 
mufc be made for their fupport ; by freely adminif- 
tering, in fmal-1 quantities at a time, flrong beef, 
chicken, or mutton broths, deprived of their fat ; 
gruel, made into white caudle, by the boiling in it 
ginger, allfpice, and whole pepper, and adding to it a 
proper quantity of fpirits : and procuring that medi- 
cal aid which fymptoms fo imminent muft require. 



DIARRHCEA, OR LOOSENESS. 



It may be fufficient, for the purpofe of (hewing 
the impciiibility of giving fuch directions, as may 
enable domeftic practitioners to take on themfelves 
the cure of this difeafe, to point out the various cir- 

cumftances 



MEDICAL ADMONITIONS. 415 

cumftances on which it may depend. A diarrhoea 
may be occafioned by too great a quantity of aliment 
being taken into the flomach ; by the peculiar nature 
of the food which has been taken ; by the digeflion 
of the food having been impeded in confequence of 
the weaknefs of the flomach and bowels ; by various 
paffions of the mind ; by difeafes of other parts, or of 
the general fyftem. Many other caufes might be 
enumerated, but thefe are furely fufficient to fhew 
the propriety of not attempting to lay down here, a 
plan of treatment applicable to every cafe. 

One caution is however neceffary, again{l the too 
prompt and indifcriminate employment of purgative 
medicines, in the onfet of the difeafe. Believing it 
never to originate, but in the irritation occafioned by 
lome matter, which, they fuppofe, cannot be too 
rapidly removed, thofe who fufFer from this difeafe, 
generally, have immediate recourfe to fame active 
purgative, to expedite the falutary procefs which 
they fuppofe nature to have inflituted. But it will 
frequently happen, that fo far from accelerating the 
cure of this malady, fuch medicines will, by their 
additional irritation, prove highly pernicious. 

Nutritive drinks fliould be taken freely, fuch as 
broths, gruel, &c. : but beyond the employment of 
thefe the patient fliould not proceed ; unlefs he is 
able clearly to af certain the caufe on which his com- 
plaint depends. DIABETES. 



4-l6 MEDICAL ADMONITIONS. 

DIABETES. 



. The fymptoms of this difeafe are here enumerated 
merely to excite thofe who fuffer from it, to attend 
to it in its early flages, when, of courfe, it muft be 
mod likely to be within the reach of medicine. 

In this difeafe, the urine is voided in a quantity 
unulually large, the tongue is white and foul, and the 
patient is tormented with exceffive third. The 
urine, when viewed in a certain direction, has a green- 
ilh hue ; and, on being evaporated, yields a large 
proportion of faccharine extract. 

A powerful inducement to thofe who are fubject 
to this malady, to make early application for relief 
mull ariie from the knowledge that an ingenious 
phyfician, who has particularly attended to the nature 
of this difeafe, which has hitherto been efteemed fo 
d .icult of cure, concludes that it is now " Jo Jar 
underfiood, as to be fuccefsfully cured.'" * 

HYSTERICAL 



* An Account of two Cafes of Diabetes Mellhus. By 
John Rollo, M. D. 

33 - 



MEDICAL ADMONITIONS. 417 

HYSTERICAL AFFECTIONS. 



As thefe are, in general, fymptomatic of fome 
other difeafe ; and moft commonly, perhaps, of fome 
particular affection of the uterine fyftem, the rules 
for their treatment can only be formed, upon a 
knowledge of thofe particular circumftances to which 
they owe their origin. 

The management of the patient during the ftrug- 
gles of an hyfteric fit, or paroxyfm, may be directed 
by the principles laid down when treating of epilep- 
tic convulfions. 

Suppreflion, or irregularity of the menftrual dis- 
charge, is very frequently the caufe of hyfterical 
affections^ Indeed, fo obvious is this caufe, that a 
cure for thefe morbid affections is generally fought 
for in fome noftrum, celebrated for its powerful ef- 
fects. But a few words on this practice cannot but 
be beneficial. 

That the moft injurious confequences may follow 
from the indifcriminate ufe of thefe violently forcing 
remedies, muff plainly appear, from ftating only one 
aflumed cafe. A delicate female, from fome acciden- 
tal caufe, fuffers a fuppreffion of the accuftomed dis- 
charge, the whole fyftem foon becomes affected, 
E e e neither 



I 



418 MEDICAL ADMONITIONS. 

neither digeftion of the food, nor the ufual converfion 
of aliment into chyle and blood, takes place to the 
required degree ; and hence a flate of extreme debili- 
ty enfues, plainly marked by a deadly palenefs, dejec- 
tion of fpirits, and a conflant difinclination to motion ; 
or rather, I inould fay, for the fake of lefTening the 
too frequent, falfe imputations of indolence, in thefe 
cafes, almoft a deprivation of the powers of motion. 
In fuch a cafe, what muft be the confequence, mould 
thefe medicines, by their violence, occafion a reftora- 
tion of the menftrual difcharge, without, at the fame 
time, producing an augmentation of ftrength ? Moil 
certainly an increafe of weaknefs and of all its atten- 
dant evils. 



DROPSY. 



In Anafarca, a ferious fluid is collected in the 
cellular texture under the fkin. By Jfcites, is meant 
dropfy of the lower belly. And by Hydrothorax, a 
preternatural collection of ferous fluid in the cheft. 

So numerous are tne caufes on which this difeafe 
may depend, and fo various are the difeafes from 
which it may originate, as to preclude a hope of ren- 
dering any fervice by their enumeration, and to render 
the laying down a general plan of cure impoffible. 
A detached obfervation or two on the noftrums 

generally 



MEDICAL ADMONITIONS. 419 

generally employed in this difeafe, is all that appears 
to be neceflary here. 

To cure the dropfy without tapping, is the promife 
of many pretenders, to whom the lives of perfons af- 
flicted with this malady are fubmitted. But, in 
general, fo violent are the remedies they employ, and 
fo rafli is their mode of a'dmimftering them, that 
fliould they even make good their promife of remov- 
ing the dropfy, it is moft probable that fo much 
weaknefs may be produced, that the patient will not 
long furvive. 

1 very lately witneffed a cafe of confirmed droply 
of the belly, in which the patient was perfuaded, by 
a domeftic practitioner, to take a ftrong inflation of 
the fox-glove ; much flronger than any phylician 
would have dared to prefcribe. The dropfy was re- 
moved, for a time ; but the difeafe of the vifcus, 
from which the dropfy proceeded, ftill remaining, the 
water again collected ; and inceffant vomitings and 
purgings, produced by the fox-glove, added considera- 
bly to his fufferings, and at length deftroyed him. 



HYDROCEPHALUS, or WATERY HEAD. 

No one, furely, can hefitate for a moment, in be- 
lieving that the treatment of this melancholy difeafe 

ought 



420 MEDICAL ADMONITIONS. 

ought only to be confided to the moft judicious and 
experienced. I fhall, therefore, only mark out thofc 
fymptoms which ought to aroufe the attention of the 
parent, and occafion him immediately to call in the 
moil powerful aid ; and point out fome circumftances, 
by an attention to which this malady may, perhaps, 
be fome times prevented. 

This difeafe generally occurs within the firft ten 
years of life. Sometimes the complaint comes on 
fuddenly, but in general it commences with a flow 
fever, and is indeed accompanied, in its beginning, by 
fuch fymptoms as to render it very likely to be mif- 
taken for an attack of the flow nervous fever. Soon, 
however, the difeafe is rendered more manifeft, by a 
difinclination to employ the mufcles on which volun- 
tary motion depends. The arms and legs are moved 
with reluctance, and the fatigue of preferving the 
body in an erect pofture is fuch, that the patient is 
always defirous of being laid down : the pain in the 
head is more conftant than in the low nervous fever ; 
and the heavinefs and dulnefs more evident : the 
pulfe is alfo ufually very flow and irregular. As the 
difeafe proceeds, the pulfe becomes quicker ; the 
child's fenfes and faculties become evidently impaired, 
the fight particularly fails him, objects appearing ex- 
ceedingly indiflinct, and the pupils of the eyes are 
conflantly dilated. Towards the clofe of this melan- 



MEDICAL' ADMofcltlONS. 42 1 

choly fcene,the urine and {tools are palled involunri- 
i-ily ; total blindnefs comes on, and a fatal termination 
takes place while the patient lays in a comatofe ftate, 
or whilft agitated with fevere convulfions. 

This difeafe may be the confequence of an original 
weak habit of body, of various other affeclipns of the 
brain, and of other difeafes which have induced a 
confiderable degree of debility of the whole fyftem. 
But one caufe, and that perhaps a very frequent one, 
more particularly demands here a few words. 

This caufe is a violent concumon or jar of the head 
from blows or falls. When the numerous accidents, 
to which children are expofed, are confidered, to- 
gether with the delicate texture of the brain, it 
becomes really a fubjecl: of furprife that this (hocking 
calamity does not more frequently occur. It however 
happens with fufficient frequency to warrant the moll 
zealous exertions for its prevention, 

. 
On this head it will not be fumcient 'to "fay, that 
care mould be taken that children mould not be 

unnecefTarily expofed to injury. Parents mufl 

excufe the fuggeftion, as it is made with a hope that 
it may prove beneficial. The correction of chil- 
dren, performed in the moment of paffion, is not 
always within thofe bounds which the parent would 
the moment before, or after the inflidion of the 

punifhment, 



42 % MEDICAL ADMONITIONS. 

punifhment, himfelf have defcribed. A box on the 
ear, as it is termed, or a fevere blow on the head 
with the open hand, is the moft ready punifhment, 
and therefore moil generally adopted, when petulence 
or paffion impels to an immediate correction. But 
when I confider the tender fabric of the brain, and 
alfo that a blow fufncient to give the intended degree 
of pain to the delinquent cannot be inflicted without 
giving a confiderable jar to the head, I mud fufpect 
it to be a mode of correction highly improper, and 
which may poffibly occafion this dreadful malady. 

The obfervation I now mail make, I am aware 
may appear to many to be bordering on frivolity ; 
but fatisfied of its real importance, I mall, without 
apology, introduce it. To endue children with 
hardinefs and caution, it has been recommended, 
rather than fmooth the way for them, to render it 
more replete with obftacles ; and rather than fhield 
them from the little injuries they would fuffer from 
their trips and flumbles, to let them feel their con- 
fequences ; that the difficulties they overcome, and 
the pain they fuffer, to-day, may furnifh them with 
courage and circumfpection to-morrow. The princi- 
ple is certainly good, therefore I propofe not to com- 
bat with it, but with a practice which has arifen 
from its improper extenfion. I mean that of neg- 
lecting to guard the head from the injuries to which 



MEDICAL ADMONITIONS, 423 

it is fubject, from thofe accidents to which child rea 
are fo frequently fubject. It was the good practice 
of parents, a few years back, to furround the head 
with a circular quilted pad, covered with filk, which, 
though not very ornamental, had no very forbidding 
appearance, and mull frequently have faved children 
from confiderable injuries of the head. I am fo con- 
fident pf this fact, that I cannot refift the impulfe of 
moll: earneflly propofing their adoption to the affec- 
tionate parent. 



THE BITE OF AN HYDROPHOBIC 
ANIMAL. 



When the mocking effects fometimes refulting 
from this injury are considered, and the uncertainty 
of fuccefs arifihg from the employment of fuch 
medicines as have hitherto been tried is alfo contem- 
plated -, the propriety of endeavouring, in this place, 
to excite every one to the prompt adoption of the 
only means of obtaining fecurity, will, I think, be 
manifeft. 

From the abforption of the faliva, conveyed by the 
teeth of the animal into the wound he inflicts, is the 
hydrophobia fuppofed to proceed. The more fpeedy 
and the more complete its removal, the lefs chance 

is 



424 MEDICAL ADMONITIONS. 

is there for abforption. Confequently, in every cafb 
of bite from an animal, in which there is reafon to 
fuppofe hydrophobia exifts, the piece fliould be im- 
mediately cut out -, fo carefully including, even the 
parts immediately furrounding the wound, both at the 
bottom and fides, that a probability (hall not exift of 
the knife's coming in contact with the wound made 
by the animal. For mould this be the cafe, not 
only would the excifion be incomplete, but the knife 
itfelf, imbued with the poifon, would ferve to multi- 
ply the infection. 

The carefully warning the wound by repeated ab- 
lutions with warm and cold water, and the application 
of a cauftic to the part, have been recommended ; 
but when our endeavour is to obtain an exemption 
from fuch a terrific difeafe, no apprehenfion of mo- 
mentary fuffering mould induce us to adopt thofe 
meafures which obvioufly do not rank as firft, in the 
probability of being fuccefsful. 



SCALD HEAD 



Is a difeafe in which little ulcers form in the fkin, 
at the roots of the hair, pouring out a difcharge, 
which generally dries on the part in a hard white 
cruft. Sometimes the difeafe fpreads over great part 
of the head, and the dilcharge is fo confiderable as to 

keep 



medical Admonitions. 425 

keep the difeafed parts in a moift ftate. When this 
is the cafe, the fcalp aflumes an honeycomb appear- 
ance. 

This difeafe is communicable by contact, and it is 
often the confequence of want of attention to clean- 
linefs. It is alfo fuppofed to be a fymptom of fcro- 
fula. 

The cure of this difeafe mould be attempted in 
this manner. The hair mould be removed freely by 
fhaving ; if the difeafe ihould be extenfive, the whole 
head fhould be fhaved ; but if it is fo flight that the 
removal of a part is lufricient, the remainder mould 
be carefully cleanfed by warning with ftrong foap-fuds. 
The fores themfelves may be rubbed with the unguen- 
ium hydrargyri nitrati of the (hops ; or with an oint- 
ment compofed of one part of the powder of white 
hellebore, two parts of flour of fulphur, and as much 
tar as will make it into a due confidence. When the 
hairs feem to be loofened, they Ihould be pulled out 5 
and this appears to be beft done by the application 
of fome ad hell ve plaifler, which, on its removal, will 
bring the hairs with it. A fubmiffion to this un- 
pleafant -and painful procefs is often neceffary to 
obtain a cure. 

Although I have here flightly Sketched a mode of 

cure of this dilagreeable malady, I jiiu'ft yet remark, 

Fff that 



426 MEDICAL ADMONITIONS. 

that it is a difeafe fo important in itfelf, and fo mucii 
more fo in its coniequences, as to render its early re- 
moval highly neceffary : regular chirurgical affiflance 
mould therefore, if poffible, be obtained. I have 
already mentioned its being efteemed one of the 
fymptoms of fcrofula ; but I fhall trouble you with 
one or two obfervations more on this point. 

When the unfortunate fufferers under this malady 
have been fubjected to it for a little time, an enlarge- 
ment of the glands on the fides of the neck generally 
takes place. This alfo being efteemed one of the 
fymptoms of fcrofula, it is in general fuppoled that 
the patient was originally fcrofulous, and that the 
icald head was the firft manifeilation of the difeafe. 
But here I venture, with the utmofl deference to the 
authorities I oppofe, to fuggeft, that fcald head may 
not be a fymptotn of fcrofula ; and that, in many of 
thefe cafes, the enlargement of the cervical glands 
may be only the confequence of the irritation of the 
abforbents originating in the difeafed parts ; and 
that fcrofula may only fucceed where this irritation is 
long permitted, and where the fubject. is unfortunate- 
ly predifpofed to this difeafe. 

I mould not have agitated this queftion, in fuch a 
work as this, a work pretending to no originality, but 
with a hope of drawing fuch a conclufion as may 
prove of real ufe. From the foregoing obfervations, 

then.. 



MEDICAL ADMONITIONS. %t| 

then, it mufl appear, that if the difeafe be removed 
at its fiiii appearance, the fwellings of the glands of 
the neck, the more ftrong chara&eriftics of fcrofula, 
may not appear > that if thefe even have appeared., 
they will difappear if the original difeafe be timely 
removed j and that, on the contrary, where the 
original difeafe has been allowed to exift long, the 
glands of the neck will become difeafed, and this 
fecondary affection may extend itfelf through the 
greater part of the lymphatic fyftem : the fcald-head, 
in confequence of neglect, having become the cauie, 
at leaft the exciting caufe, of fcrofula. 

The importance of an early and judicious oppofi* 
tion to this difeafe, muft, from the above considera- 
tions, be obvious. I have, therefore, only to repeat, 
that it is a contagious difeafe ; and to recommend, 
that, on its appearance, thofe whom it attacks fliould 
be carefully feparated from other children. 



THRUSH, 



Aphthous ulcers in the mouth itldoiii happen to 
grown perfons, except fome considerable diforder of 
the fyftem exifts at the fame time, or has juft pre- 
ceded. In children they occur very frequently, and 
even at times when the child appears, in Other re- 



428 MEDICAL ADMONITIOK$. 

fpec~b, perfectly well. Improper food is perhaps a 
principal caufe of their occurrence, fince thofe children 
who are robbed of their natural food, and crammed 
with mixtures of bread and water, &c. which are often 
given much too hot, feem much more difpofed to this 
complaint, than thofe children, whofe mothers have 
it in their power, and are difpofed, to fupply them 
with the food which nature has appointed for them.* 

Breathing 

* The thrufh almofl always afFe£is thofe children who 
are attempted to be dry-nurfed. Gripings, conftant diarr- 
hea, rapid wafte of ftrength and of flefh, are almoft the 
certain harbingers of fpeedy death to the poor little vi£lim, 
doomed to perifh for want of that nutriment which nature 
had defigned and bounteoufly provided. 

" Connubial Fair ! whom no fond tranfport warms, 

To lull your infant in maternal arms ; 

Who, blefs'd in vain with tumid bofoms, hear 

His tender wailings with unfeeling ear ; 

The foothing kifs and milky rill deny 

To the fweet pouting lip, and glift'ning eye ! — 

Ah ! what avails the cradle's damafk roof, 

The cider bolfter, and embroider'd woof ! 

Oft hears the gilded couch unpitied plains, 

And many a tear the tafTal'd cufhion ftains ! 

No voice fo fweet attunes his cares to reft, 

So foft no pillow as his mother's bread !" Darwin. 

To fuch of my fair readers who are difpofed to liflen to 
Oie voice of admonition, on this important fubjeft, I earneft- 
ly recommend the perufal of the charming poem of The 
Nurse, by Mr. Rofcoe. 



MEDICAL- ADMONITIONS. 429 

Breathing the confined and impure air of the bed and 
,bed-room, during the month, where due attention 
to cleanlinefs and ventilation is not attended to, may- 
be another caufe of this difeafe. A .difordered ftatc 
of the ftomach and bowels may alfo be coiifidered as 
a caufe of the thrulh. 

Unlefs the caufe of the difeafe can be afcertained, 
there will be very little probability of adopting a fuc- 
cefsful mode of treatment. Enquiry, therefore, mud 
be made into the kind of food with which the child 
is fupported. In general, this will be found tobe 
improper, and not fufficiently nutritious : this fault 
muft be therefore corrected ; the child muft be al- 
lowed to breathe a purer air, and particular regard 
muft be paid to the date of the bowels. As this dif- 
order may depend on fo many different circumftances, 
it is not poffible to point out here the medicines 
which will be required. But I cannot allow this 
opportunity to pafs without calling the attention of 
parents to the cruel practice, frequently adopted by 
nurfes, of cleanfing the mouths of children afflicted 
with the thrum, by rubbing the infide of their mouths 
roughly, with a piece of linen cloth wrapped round a 
piece of flick, and dipped in a mixture of Armenian. 
bole and honey. Whoever has witneffed this opera- 
tion, muft have perceived that it has occafioned the 
little fufferer very considerable pain ; and a very Iktb 

consideration 



430 MEDICAL ADMONITIONS. 

confederation will ferve to convince, that the pain 
thus inflicted is unnecefiary. The aphthous fores 
which conftitute the thrufh are filled by gangrenous 
floughs, theie either adhere to the living parts, or are 
feparated from them. If the former be the cafe, there 
is very little likelihood that the floughs will be re- 
moved by friction, however feverely employed : if, on 
the other hand, a feparation have taken place, no 
force is necelTary for their removal. In both cafes, it 
is entirely fufneient, that whatever applications are 
refolved on, (hould be of a tenacious confidence, and 
be put into the child's mouth from the end of a tea- 
fpoon ; the action of the child's tongue, which 
neceflfarily follows, being quite fufficient for the dif- 
fufion of the remedy, and for its application to the 
affe&ed parts. 



SWALLOWING OF PINS, &c. 



Children, from their being playfully difpofed 
to put various fubftances in their mouths, are liable 
to have hard and fnarp pointed fubftances pafs into 
the gullet, and even into the ftomach. By the filly 
practice of putting pins, &c. into their mouths, adults 
are alfo expofed to the iame mifchiefs. Pieces of 
bones, griftle, &c. fometimes flop in the gullet, and 
afford confiderable diftrefs ; but thefe may in general 

be 



MEDICAL ADMONITIONS. 43" I 

be fpeedily removed by a piece of whalebone, to one 
end of which is affixed a button of fponge. 

If a pin, or any other fharp-pointed fubflance,- 
fhould flick in the gullet, beyond the reach of the 
foreceps or nippers, it is indeed a cafe which calls for 
the utrnoft exertions of patience from the unfortunate- 
fufferer, fince it will in general be found much better 
to wait the fpontaneous loofening of the fubftance, 
which may happen much fooner than could be ex- 
pected, than torifque additional injury, by employing- 
the means ufually recommended, which are the palling 
of the fponged probe, and the adminiflering of a 
vomit. Unhappily the petition of the pin, for in- 
fiance, cannot be known, and it is not at all unlikely- 
that the prefTure of the fponge, or the urgings to 
vomit, may more deeply infix the point. Farther, it 
may be obferved, with refpect to an emetic, that 
mould the patient unhappily, during the firft. urgings 
to vomit, experience excefiive pain, from which it is 
concluded that the pin laying acrofs the throat, every 
exertion ferves to fix it deeper, we are obliged to wit- 
nefs this addition to his fu&rings without affording 
relief, not having it in our power to flop the vomit- 
ing, until the flomach is cleared of the emetic. 

It is too prevalent a practice, when any fubftance' 
of this kind has paffed into the flomach, to endeavour 
to haften its paffage through the bowels, 'by giving 

fome 



432 MEDICAL ADMONITIONS. 

ibme opening medicine. Juft the contrary conduct 
to this fhoiild be adopted. Milk, alone, or mixed 
with eggs unboiled, fliould be immediately taken, as 
by the coagulation which takes place, the fubftance 
may become To involved, as to prevent its doing 
injury to the ftomach ; and on the lame principle 
fliould opening medicines, which render the feces 
thin, be avoided ; as, by allowing the faeces to obtain 
iome firmnefs, there will be the greater probability of 
the pointed parts of the fubftance being fo Eheathed, 
as to prevent them injuring the inteftines. 



BOIL. 



A boil is a circumfcribed hard tumour, exquifitely 
fenfible, fpreading below the furface, and riling very 
little above the level of the fkin. Its fize is in 
general about that of a pigeon's egg. After it has 
exifted a few days, a trifling difcharge of matter hTues 
from a fmall opening in the moil prominent part of 
the tumour, a Hough remaining at the bottom, which 
is, in general, a considerable time before it is fepa- 
rstcd. 

Boils, unlefs they are very large, and happen in 
debilitated conftitutions, although productive of con- 
ficferabie pain and inconvenience, are without danger, 

and 



MEDICAL ADMONITIONS. 433 

and will often do well without chirurgical aid -, but, 
in general, the cure Will be accompliihed much 
fooner, and the patient fpared much inconvenience, 
by a free opening, and other affiftance, which cannot 
be well obtained but from the hands of a ftirgeon. 

In general they may be brought into a good ftate, 
by the application of warm fomentations, and emolli- 
ent cataplafms : when a tolerable opening is obtained, 
the ulcer may be drafted with any mild digeftive 
ointment > and in general the cure will be completed 
without much difficulty. Attention muft alfo be 
paid to the general ftate of the fyftem ; fince if that 
particular ftate on which they depend is not changed, 
the patient may be harraffed for a confiderable time, 
by their making their appearance in different parts of 
the body. With the hope of producing this change, 
domeftic practitioners, in general, adopt a practice 
which muft often prove very injurious : that of put- 
ting the patient under a long courfe of draftic purga- 
tives. That this practice muft often be fucceeded 
by ill cOnfequences, muft be evident, when it is con- 
lidered, that the great eft benefit to be obtained in 
fuch cafes is from the ufe of tonic and ftrengthening 
remedies, fuch as the bark, fea bathing, 8cc. 

G g g ANTHRAX, 



434 MEDICAL ADMONITIONS. 

ANTHRAX, OR CARBUNCLE. 



At its commencement, anthrax has much the ap- 
pearance of a common boil, but it foon puts on ap- 
pearances which point out the malignity of its nature : 
the rednefs and hardnefs extend themfelves very wide, 
although the tumour is raifed but very little above 
the level of the fkin ; fmall puflles come out on the 
furface, which have the appearance of being only 
fuperficial, but the openings which they leave evident- 
ly reach to the large fphacelated bafe which pofTelTes 
the place of the cellular membrane ; about the middle 
of the tumour the colour is of a deep crimfon, inclin- 
ing to purple, becoming paler and mottled toward 
the circumference ; the furrounding integuments are 
generally found by preffure to be in an cedematous 
ftate. Several of thefe fometimes appear at the fame 
time ; but moft commonly a fingle one occurs, 
which fpreads to a great extent. 

The Cure of Anthrax. By the exertion of 
a fkilful furgeon, and the moft fcrupulous exactnefs 
in purfuing his directions, this terrible difeafe is iome- 
times cured -, but the ftate of the body which exifts 
is fuch as mud always render the event highly to be 
feared. To treat, in this work, of the chirurgical 
treatment of this difeafe, would be prefumptuous and 

ufelefs ; 



MEDICAL ADMONITIONS. 435 

ufelefs ; fince it is of too ferious a nature to admit of 
the triflings of family pra&ice. A confiderable op- 
portunity, however, always offers itfelf for the friends 
of the patient to evince their zeal, and affift in the 
cure : for fo much affiduity is required, in adminif- 
tering proper cordials and nourifhment, that it ought 
hardly ever to be entrusted to the care only of an 
hired attendant. 

From their great fimilitude at their firft appearance, 
there is much reafon to fear, that the carbuncle, at 
its commencement, is often miftaken for a common 
boil — a miftake which may be productive of the moft 
dangerous confequences, fince in carbuncle the ex- 
ertions for faving the patient mull be very confidera- 
ble and unremitting : the treatment which is ordi- 
narily adopted for a common boil, would, therefore, 
allow the difeafe to make fuch a progrefs, that art 
might afterwards be of no avail in endeavouring to 
fave the patient. 



INFLAMMATION AND ABSCESS GF THE 
BREAST. 



Inflammation of the bread may be judged to 
have taken place from heat, rednefs, and pain, pofTeff- 
ing a part or the whole of the breaft. When the 

difeafe 



436 MEDICAL ADMONITIONS. 

difeafe is confiderable, it is ufually preceded by a miver- 
ing, and accompanied by fever. The milk continu- 
ing to be fometimes fecreted into the bread, without 
any difcharge of it being obtained, the breaft necefTa- 
rily becomes tenfe and heavy. 

The inflammation of the breaft may happen without 
being able to afcertain any caufe. But, in general, it 
may be traced to one or the other of thefe caufes — 
expofure to cold, repreffing the difcharge of the milk, 
or external violence. 

To remove this difeafe by refolution, the means 
mould be had recourfe to in the early part of the 
difeafe. When, if the difeafe exifts in a very con- 
fiderable degree, blood may be taken from the arm, 
in a quantity proportionate ; but, in general, large 
bleedings are not required in the cure of this difeafe, 
the lofs of fmall quantities by topical bleedings 
generally proving fufficient for the intended effect. 
Gentle purgatives are proper, and a preference mould 
be given to fuch as contain fome of the neutral falts in 
their compofition, fince thefe will alfo tend to increafe 
the difcharge of urine. To leffen the fecretion of 
milk, no more aliment mould be taken, than may be 
juft fufficient to fupport the ftrength of the patient. 
To promote the abforption of that which is fecreted, 
the breaft may be frequently bathed with camphorat- 
ed oils, ufmg, at the fame time, a moderate degree of 

prefTure. 



MEDICAL ADMONITIONS. 437 

preflure. To lefTen the ill effects refulting from its 
fenfion and weight, the milk may be drawn at proper 
intervals, and the breaft fufpended by means of proper 
bandages, and the increafed action of the inflamed 
part be leflened by the ufe of proper cooling appli- 
cations. 

If the inflammation does not feem likely to be 
difperfed, but fuppuration appears to be advancing, 
recourfe muft be had to warm and emmollient fer- 
mentations and cataplafms. AbfcelTes, in the breaft 
in general do very well, when allowed to break fpon- 
taneoufly ; but there . are many cafes, where the 
afliftance of the furgeon prevents numberlefs incon- 
veniences, and very much accelerates the cure of the 
difeafe. 

The inflammation may be either outwardly, in the 
integuments, or it may poflefs the centre of the breaft. 
Much need not be faid to make it believed 3 that the 
latter is much the worft cafe, and requires the greateft 
exertions for its removal.- 

Frequently, however, in thofe cafes where the 
patient has been fatisfled with the afliftance of fome 
family pra&itioner,, (lie will be under the necefiity, at 
the conclusion of the difeafe, to have recourfe to a 
regular furgeon, for the removal of a dilagreeable 
hardne£ 5 which often continues for fome time after 

the 



438 MEDICAL ADMONITIONS. 

the inflammation has ceafed ; which, although it is 
not of the fame nature with fcirrhus and cancer, will 
often require the greateft fkill to afcertain its moft 
proper mode of treatment. 



CHILBLAINS. 



A chilblain is an itching and painful fwelling, 
produced by the action of cold, fometimes terminat- 
ing in ulceration. 

Tumefaction, rednefs, and itching of the part, are 
the firft marks which denote the coming on of chil- 
blain. The fwelling afterwards extends beyond the 
rednefs to the furrounding parts, which, upon preffure, 
will generally be found to be in an cedematous ftate ; 
the redneis gets darker, until at laft it becomes of a 
deep crimfon, or even of a livid colour ; the itching 
increafes to fuch a degree, as to become almoft intole- 
rable, and is accompanied with aching pain. If the 
mode in which the complaint is treated does not 
prove equal to the removal of the difeafe, it may con- 
tinue, nearly in the fame ftate, for a confiderable time, 
or may terminate in ulceration. Before this happens, 
the complaints increafe, and a blifter filled with 
bloody water arifes, after the breaking of which, a foul 
painful ulcer fucceeds, which, if not properly treated, 

will 



MEDICAL ADMONITIONS. 439 

will extend itfelf, both in depth and width, affecting 
the tendons, and even the bones themfelves. 

Children, and young perfons who ufe but little 
exercife, are moft difpofed to this complaint, which 
generally comes on with the winter, and, if powerful 
remedies are not had recourfe to, will continue until 
the return of mild weather. Thofe who have once 
fuffered from this difeafe are obferved to be much 
difpofed to a return of the complaint in the fucceed- 
ing winter. 

When this difeafe is only in a trifling degree, there 
is no neceflity for application to a furgeon : the reme- 
dies afforded by domeftic medicine are here frequently 
fufficient. 

To flrengthen the veifels of the part, fo that by 
their action the blood, which feemed to be ready to 
ftagnate, may be propelled through them, is the chief 
principle which fliould regulate the mode of treat- 
ment. With this view, the parts affected mould be 
frequently rubbed with the naked hand, or with 
flannel ; as much exercife mould be ufed, as the ftate 
of the difeafed parts will allow ; and if there be no 
fore, ftimulating medicines, fuch as camphorated 
fpirits, fpirits of turpentine, warm fomentations, plaif- 
ters, &c. fhould be applied to the parts affected. 
Sudden and confiderable changes from cold to. heat 

iliould 



446 MEDICAL ADMONItlONS. 

ihould be avoided ; and, laflly, the parts (hould be 
defended from the action of cold by coverings of fuch 
fubftances as are known to have but little power in 
conducting heat, fuch as fiightly woven woollen and 
cotton, warn leather, which is loofe in its texture, 
and downy on each fide. 

When the chilblain becomes ulcerated, the ulcer 
muft be treated according as its appearances may 
indicate, it being impoiTible to lay down a mode of 
treatment which ought to be adopted in every cafe, 
fince the part affected is capable of putting on all the 
varieties of ulcers from other caufes, and confequent- 
ly may demand, in fome cafes, a different, or even an 
oppofite treatment, to what it may require in others. 

To prevent this difeafe, early recourfe may be had 
to the means above recited for its cure, efpccially io 
far as refpedte exercife, friction, and preventing the 
ad ion of cold. 



WHITLOW. 



The whitlow is an extremely painful inflammatory 
tumour, poffelTmg the end of the finger. 

One fpecies of this complaint begins with a con- 
fiderable burning pain ; but the &in fc-on becomes 

elevated 



MEDICAL ADMONITIONS. 441 

elevated around the nail, and the whole end of the 
finger, and becomes filled with a famous liquor - 3 the 
cuticle and contained fluid appearing almoft tranf- 
parent. 

Another fpecies has its iituation much deeper than 
the former, the inflammation attacking the tendons 
and ligaments, and the intervening cellular membrane. 
The pain, at the commencement, and during the 
progrefs of this fpecies, is much more violent and 
throbbing than that of the former fpecies ; the pain 
being felt over the whole hand, and oftentimes even 
along the arm ; both the hand and arm, in fuch cafes, 
becoming conliderably fwelled. The fuppuration. 
proceeds extremely flowly ; and when the matter is 
formed, it is fo deep feated as to be a confiderable 
time before it makes its way to the furface. By the 
violence of the pain, fever, delirium, and convulfions 
are fometimes produced ; the whole nervous fyftem 
fuffering fuch a derangement, that inftances are 
known where death itfelf has been occafioned by this 
malady. 

AbfcefTes frequently form along the courfe of the 
lymphatics, even as far as the arm-pit. The tendons 
fuffer frequently fo much, that the fingers become 
ftiff and immoveable ; the bone alfo fometimes fuf- 
tains fo great a degree of injury, as to render the 
Hhh amputation 



442 MEDICAL ADMONITIONS. 

amputation of at lead the laft joint of the finger, 
neceffary. 

Whitlows may be produced by external injuries, 
fuch as a puncture, bruife, or flight wound. There 
have been many inflances of the worll kind of this 
difeafe immediately fucceeding to the moll trifling 
and fuperficial punctures ; but they happen mod fre- 
quently from fome internal caufe, or, at leaft, from 
caufes that cannot be afcertained. 

In the firft fpecies, no application is preferable to 
that of a bread and milk poultice : the tumour be- 
ing opened, when in a proper (late, a continuance of 
the fame application will generally fcon complete the 
cure. 

In the other fpecies, as early an application as poffi- 
ble mould be made to a furgeon, fince this malady 
will require every poffible exertion to prevent the oc- 
curring of thofe evils above mentioned. Sometimes, 
indeed, when the difeafe is feated in thofe parts 
which are in immediate contact with the bone, the 
injury is communicated to the bone itfelf, in fo 
early a ftage of the difeafe, that it may be imporlible 
for the raoft ikilful furgeon to fave the difeafed bone. 

SCIRRHUS 



MEDICAL ADMONITIONS. 443 

SCIRRHUS AND CANCER. 

The parts which are moft commonly affected by 
this difeafe are the breads of women, the arm-pits, 
noftrils, tefticles, uterus, rectum, fcrotum, &c, 

A fcirrhus in the breaft commences with a very 
fmall, hard, and moveable kernel, which often re- 
mains a •conliderable time, without pain, and without 
increafe of magnitude ; but, after fome time,,it in- 
creafes, both in fenfibility and fize. A flight tingling 
alfo takes place in the parr, and this gradually in- 
creafes, until it terminates in a painful fenfation, 
which at length becomes acute and lancinating. The 
tumour, as it increafes in magnitude, becomes more 
fixed, and more irregular in its figure. The veins 
which run juft under the fkin, are enlarged, and the 
fkin itfelf gets difcoloured in feveral parts ; a fluid is 
difcoverable underneath thefe difcolourations, which 
exudes, when ulceration takes place. The ulcerations 
which fucceed are very irregular in their figure, and 
but why proceed in the defcription of this dread- 
ful calamity ? Sufficient muft have been faid, to have 
furnifhed information to fecure its detection at its firft 
appearance ; and but little more, I hope, need be 
faid, to fully prove the neceffity of a refolute fubrnif- 
fion to its early removal. 

The 



444 MEDICAL ADMONITIONS. 

The hope of exciting in the unfortunate fufferer 
the degree of courage required to get rid, at firft, of 
an evil, which becomes dreadful by fufferance, will 
induce me to employ the greater part of this article 
on that important object. 

This difeafe I have already defcribed as commen- 
cing with a very [mall kernel. If, upon a proper ex- 
amination, which, immediately on its difcovery, Ihould 
be obtained, this fmall kernel be afcertained to be a 
true fcirrhus, the patient fhould confider, that nothing 
but its fpeedy removal, by the knife, can be depended 
on, to prevent its termination in cancer. It mould 
alfo be confidered, that during this ftate of the difeafe, 
the operation is comparatively trivial, and requires 
but very little time for its performance ; that the 
pain which accompanies it is very far fhort of that 
which is imagined ; and that the exemption from 
future difeafe is rendered, by it, almoft certain. 

It is worthy of remark, that the oppofition to this, 
and indeed to every operation, does not proceed fimp- 
ly from the dread of pain ; but from an aflbciation 
of the moft horrid ideas of every minute circumftance, 
refpecting the operation, which can be fancied. The 
affemblage of the furgeons, the preparation of instru- 
ments, and many other circumftances, the enumera- 
tion of which would be oppofite to the prefent pur- 
pofe, are all reprefented in a colouring fo fombre, and 

with 



MEDICAL ADMONITIONS. 445 

with touches fo mafterly and impreffive, that the 
mind is filled with the utmoft horror at the picture 
the imagination has drawn. Reafon has no longer 
power to exert its influence ; and the unfortunate 
fufferer, thus becoming the Have of terror, attempts 
not to argue and combat with the hofl of terrific 
Spectres which fancy is conftantly placing before the 
eyes. 

When I confider how powerfully the dread of an 
operation affects the mind, I cannot indeed expect to 
effect much by argument. Some little good may 
however, perhaps, follow, from this analyfis of the 
ordinary procefs of the mind in this and fimilar cafes. 
Since it thus plainly appears, that the dreadful appre- 
hension of the operation is formed, in a great meafure, 
by the mind's dwelling on objects entirely vifionary, 
and that the fear of Suffering pain has, perhaps fome- 
times, the leaft influence in directing the oppofition 
to the operation recommended. Thus, we often fee 
men who can bear pain with the greateft fortitude, 
declare, that although they well know the pain of the 
operation does not exceed that occasioned by the 
fcratch of a pin, yet they can with difficulty bring 
themfelves to confent to fuffer the operation of— 
bleeding. Nor can it hardly be doubted, if the mod 
timid female, Suffering under this difeafe, was aflured, 
that if fhe would permit the pain of the part to be 
augmented exactly to the fame degree, and for the 

fame 



446 MEDICAL ADMONITIONS. 

feme period of time, as it would by any propofed 
operation, fhe fhould obtain an entire removal of the 
diieafe, and even indeed of the part itfelf, and this 
merely by an incantation, but that her content would 
eafily be obtained. But, indeed, it is not neceflary 
to imagine a cafe, to fhe;v th,at the dread of opera- 
tions does not depend merely on the fear of pain, as 
this is fufnciently evident from the much more ready 
fubmiffion to the application of cauflics ; even under 
the ftrongeft conviction of their producing a much 
greater degree of pain, and of their affording a con- 
iiderable lefs chance of a cure. 

The mode of thinking which mould therefore be 
adopted, by thofe to whom fuch an operation has 
become neceiTary, is to let the mind dwell only on 
the abfolute pain of the operation, abftracted from all 
foreign circumftances and vifionary terrors ; and to 
confider, that a cure may be obtained by only a few 
minutes increafed pain ; and this pain very far fhort 
indeed of what is mod probably anticipated by ima- 
gination : but fuppofe it ever fo violent, let it be 
remembered, that it is but fuffering, even fay ! the 
moft excrutiatiating pain, for a few minutes, to pro- 
cure an entire liberation from mifery and defpondence. 

But, unhappily, there are many, whofe dread of 
chirurgical operation is fo great, that no argument or 
confideration can overcome. To thefe it is proper 

to 



MEDICAL ADMONITIONS. 447 

to addrefs all the confolatory language that truth will 
allow ; and, therefore, to affure them, that this mala- 
dy, although perhaps incurable, and accompanied by 
moft difireffing circumftances, is yet, in general, not 
attended with thofe excruciating pains which are fup- 
pofed always to belong to this malady. If, indeed, 
the poor fufferer is induced, by the miftaken zeal of 
fome fympathifing friend, to place herfelf under the 
care of fome of thofe impoftors who have acquired 
the character of cancer- curers, this may not be the 
cafe, but the pains may become cruelly aggravated, 
and the progrefs of the dileafe rapidly accelerated. 

1 am well aware, that many of my readers will be 
ready to afk, But do not thefe, whom you have thus 
fbgmatifed, frequently effect cures, even in thofe cafes 
which have been deemed cancerous ? It is therefore 
neceflary to obferve, that tumours in the bread fre- 
quently fucceed to the inflammation of the bread, 
arifing from retention of the milk, which, although 
they are certainly not of a cancerous nature, do often 
poflefs thofe appearances which render it very dim- 
cult to make the neceflary diftin&ion, and will con- 
tinue under that form for feveral months, and at lafl 
refolve, perhaps, by the application of a bread and 
milk poultice. Thefe are the cafes which prove fo 
favourable to the character of this clafs of practitioners. 
From their fize, hardnefs, and length of duration, 

they 



448 MEDICAL ADMONITIONS* 

they commonly gain from the patient and her friends 
the epithet cancerous ; and fhould any profefiional 
man, deceived by an imperfect hiftory, drop a fufpicion 
of an unfavourable termination of the cafe, the foun- 
dation is laid, on which the reputation of fome igno* 
rant pretender may be railed. 

When the furface of the fkin is attacked by cancer, 
it generally begins with a fmall excrefcence of the 
warty kind, which becomes a cancerous ulcer on fuf- 
fering even a flight irritation : fuch are the cancers 
which appear in the face. The. extirpation of thefe, 
at their firft appearance, may be accomplifhed by an 
operation by no means remarkable for its feverity. 

Cancer of the womb is commonly preceded by a 
very confiderable difcharge ; much pain is felt at the 
bottom of the belly, darting in different directions, 
but chiefly down the thighs. As the complaint pro- 
ceeds, the pains become more pungent and forcing, 
and at length ulceration taking place, a profufe dif- 
charge of varioufly coloured matter, very acrid and 
offenfive to the fmell, enfues - y the general ftate of 
the f\ ftem fympathifing with the local injury, hectic 
fever is induced. 

SCALDS 



-, - 



MEfelfe&t AiMoinfiotfs. 4-49 

SCALDS AND BURNS. 



■JDr» Underwood obferVes, thar>— A ftrong {blution 
©f foap in water has long been in ufe with artificers* 
employed in any bufinefs expofing workmen to very- 
bad fcalds 5 and is a very excellent remedy. But -as 
the foap would take fome time in diflolving, and the 
folution fome time in cooling, the do&Or recommends 
a mixture of fix ounces of oil to ten of water, with 
two drachms of the ley of kali, Or pof-afh. This 
quantity may be furlicient for a burn on the hand or 
foot, which is to be immerfed, and kept about half 
an hour in the liquor, which will remove the injury, 
If had recourfe to immediately ; but muft be repeat- 
ed,.^ the pain may require, if the fcald or burn be of 
fome ftanding. Should a perfon be fcalded all over, 
and immediately put into a cold bath of this kind, 
and the head, at the fame time, be frequently im- 
tnerged, or well wafhed with the liquor, I believe, 
the Dodor fays, very little injury would enfue. 

The mcfb ufeful application, I think, with Which 
families can be provided, againft the moment of 
emergency, is a ftrong brine, made by placing Hiced 
potatoes and common fait in alternate layers in a pari, 
allowing them to remain until the whole of the fait is 
liquified ; which muft be then drained off, and kept 
iii bottles, properly labelled, ready for immediate ufe. 
I i i Linfeed 



450 MEDICAL ADM0KITI0NS. 

Linfeed oil, fo frequently recommended, mould 
never be the firft application ; fince it poflefles little 
or no power in preventing the inflammations of the 
parts, and by greafing the fkin, defends it entirely 
from the action of thofe remedies which would prove 
beneficial, if applied immediately in contact with the 
ikin. 

The ulcerations which fucceed to fcalds and burns 
demand fo much nicety in their management, as to 
require the care of a fkilful furgeon. Without this, 
the patient may be .diflreffed by inconveniences for 
the reft of his life, which no fubfequent endeavours 
may be able to remove : the moft unfufpected adhe- 
fions of parts naturally feparatcd, and the moft rigid 
contractions of parts, which before were flexile, will 
frequently take place, ncceflarily occafioning the moft 
diftreffing deformities. 

Extraordinary inflances fometimes occur, of thofe 
whofe clothes have by accident taken fire, efcaping in 
a wonderful manner, by adopting the ufe of fuch 
means as have been dictated by an extraordinary 
prefence of mind. But rather than truft to that 
which is fuggefted in the moment of terror and con- 
fuflon, by a mind totally unfurnilhed with any fixed 
mode of proceeding, it will perhaps be better to lay 
down certain rules, which being ftrongly imprinted on 
the mind, will ferve to direct to the moft fafe and 
beneficial line of conduct. To 



MEDICAL ADMONITIONS. 45I 

To call for help 'presents itfelf to the mind fo in- 
stinctively, that it would not be mentioned here, but 
to remark, that this mould be done, if poflible, by 
ringing the bell,. &c. without opening the door o£ 
the apartment, as the external air ruftiing in, would 
immediately increafe the rapidity of the progrefs of 
the flames. 

The firft attempt mould be to tear off that part of 
the clothing which is in flames ; and, if in a parlour, 
to feize the water decanter, and which, even for this 
reafon alone, Ihould be large, and kept always full ; 
or any other veffel of water, which may be in the 
room where the accident has happened, mould be 
recollected and flown to. 

If unfuccefsful in thefe inftantaneous exertions for 
relief, the unfortunate fufferer mould feat himfelf on 
the floor, remembering, that in this pofture (he will 
fee better enabled to fmother the flames of her lower 
garments, and that an upright pofture will render the 
communication of the flames to the upper part of her 
drefs more probable. 

In this fituation, fhoujd these be a hearth carpet 
(which even for this ufe, in this moment of emergen- 
cy, fhould form part of the furniture in every room,) 
it will, from the materials of which it is compofed, 
prove highly ufeful in extingui thing the flames, laid 
over the burning clothes, or wrapped tight round 
them. Females 






4$2 MftVtCAh AT>MONITX0»K 

Females' are mofl commonly the fubje&% o£ tiiis 
terrible accident,, owing to their clothing being of a 
more combuftible kind than thofe of men. Wooden 
clothes not only burning much flower than liB^n Q* 
cotton, but giving an alarm much fooner, by the. 
fmell their burning occafions. Females, therefore, 
whole age or infirmities almofl confine them to their, 
lire -fide, and prevent the hope of any adlive exertions, 
.fhould be perfuaded to wear gowns and aprons of 
filk, or of fluffs of force fabric in which worfted and 
fiik are blended, inftead of muflin and fine linen ^ 
which not only will catch fire almoft with a fpark, but 
will burn with the utmoft rapidity. 

c 

— 

EFFUSIONS OF BLOOD FROM RUPTUR- 
ED OR WOUNDED VESSELS. 

"Were the knowledge of the fituation of the 
biood-vefiekof the extremities., fo far as isneceffary for 
checking dangerous erTufions of blood, and the ufe of 
the tourniquet, more general ; not confined to the 
navy and arrriv, but extended to colleges and fchools, 
particularly military and nautical academies, manu- 
factories, h'ofpitals of every defcription, prifons, plan- 
tations, fire-offices, the clergymen of parifhes in which 
no fur^eens are refident, commanders of merchant- 



l»en,- miners, &c. it coul4 not tail of proving- highly 
beneficial tQ mankind"* 

Convinced, witli the benevolent author of the put?- 

■ ■. 

lication from which this and the lucceeding quotations 

are taken, of the advantages to be derived from the 

wide diffufion of fuch knowledge, I have inferted the 

following paragraphs : but at the fame time muft exr 

prefs a wifh, that they may incite my readers to £ 

perufal of the little work itfelf, as the lefions it teaches 

cannot be too plainly imprinted on the mind. 

*' The veffels, or tubes, which proceed from the 
heart, to convey the blood to all parts of the body ? 
are called Arteries. From the power with which 
the heart propels the blood through {his fyftem of 
veffels, it happens, that,, whenever they are wounded, 
the blood flows rapidly, and in jerks, from the wound* 
ed part. They divide, to be diflributed to parts ? 
from trunks, like the branches of a tree from th$ 
body ; fo that,- 'on preffing together the fides of any 
trunk, the flow of blood into the branches beyond jth© 
comprefled part is prevented, 

** The veffels, which return the blood to the heart, 
arc named Veins. In them the blood receives but 
little of the impelling, force of the heart, and, there - 

■ :. ; ........ & re » 

* A Left Ore on the Situation of the large piood-VefTels 
fefOje Extremities, &c. &c. by Williarm Blizard, F. R. S. 



454 MEDICAL ADMONITIONS. 

fore, moves not with a ftrong tide, or current, but 
glides evenly and gently on, like the ebbing water j 
and, of confequence, wounds of thefe veflels are. not 
of much importance ; a fmall degree of refiftance, by 
a finger, or fome folded linen, applied to the wounded 
part, will generally flop the bleeding. 

" It is very plain, then, that if a bandage or liga- 
ture be made fufflciently tight around any limb, the 
flow of blood into all the parts below mud be pre- 
vented. But, to render this certain, theprefiure muft 
be very great in the whole circumference of the limb ; 
and, in fome cafes, from the fituation of arteries be- 
tween bones, the effect cannot be obtained. To 
perform this procefs, therefore, fuccefsfully, in cafes 
of wounds and operations, and, at the fame time, to 
prevent the confequences of an exceedingly ftrong 
general preflure, furgeons have fixed on certain parts 
of the trunks of arteries, before their ramifications, 
for the application of a pad, or Compress. 

" The Pulse is the beating or diflending of an 
artery, from blood propelled into it by the beait. 
The fpaces of time between the pulfations are periods 
when the heart itfelf is filling with blood returned to 
it by the veins. 

" Now it is evident, that there can be no pulfa- 
tion when the flow of blood and pulfation of an artery 

are 



MEDICAL ADMONITIONS.' 4££ 

are prevented. Where, then, a pulfe can be conve- 
niently felt, as in the wrift, the ceafing of it, from a 
preffure being made on the trunk above, will prove 
tjiat the preffure is made effectually. To illuftrate 1 
this by experiment — Let a friend feel the pulfe in 
your wrift ; then apply two or three fingers in the: 
little pit immediately below the collar-bone, clofe to the 
flioulder. Prefs ftrongly, and the pulfe will ceafe, 
becaufe the artery that fupplies the upper extremity 
pajfes under the collar- bone, over the firjl and Jecond 
ribs, along this part, and will now be preffed againfl 
one of thefe ribs. Remove the fingers, and again 
apply them, and the pulfe will be found to alternate 
with the preffure. 

" Suppofe, then, a wound to be received, an artery 
of confiderable fize to be cut or torn, and a copious 
bleeding, in confequence, to happen, in any part of 
the arm below the place juft defcribed : it appears 
manifeft, that, by making a preffure with the fingers, 
in the manner defcribed, or afiifted by a pad between 
the fingers and the part, the bleeding would inftarYtly 
ceafe. 

"The arteries of the upper extremity, or arm, 
proceed from the trunk after this manner : the trunk 
pajfes into the arm-pit, deeply filiated ; it then proceeds 
along the fide of the arm* next the body, obliquely to- 
wards the fore part of the joint or bend y and here di- 
vides 



vides into thtf t branches. In this courfe to m divifidB 
it lies near the bone, and may therefore be fttcdefeftiVi 
ly comoreffed* ■ - - • 

" The diflribution of the veitels of the lower ex- 
tremity is in this way : the artery paffes from the 
cavity of the belly to the Groin, where, in thin 
perfons, the pulfation of it may be felt. 

" At this place, in cafe of wound and cffufioti ofr 
blood very high in the thigh, effectual comprefiioft 
may "be made, by fome fingers preffed very ftfongly, 
an the manner defcribed for compre&on below the 
collar-bone ; though it were better to have fome kind 
of ftrong pad, or firm body, fuch as will be described, 
interpofed between the fingers and the part. From 
the groin, the artery proceeds in an oblique direction, 
downwards and inwards, and at about the middle of 
the infide of the thigh it lies clofe to*the bone. This 
is the moft favourable part for making a prefture 
upon it, becaufe of the refiflance of the thigh-bone 
behind. And, where there are opportunities of choice, 
as in cafes of rounds, or operations below this part, 
this is the place which furgeons fix on for the appli- 
cation of the compretTing body j it therefore deferves 
particular attention. 

'" The courfe of the veffe) is then downwards and 
backwards to the Ham ; in the hollow ofzvkich, againfi 
the IcwerJltU end cf the thigh-bone, compreffion may 

again 



MEDICAL ADMONITION 457 

lift be very fuccefsfully made, in all cafes of wounds 
or operations below the knee joint. But beyond this 
part, compreffion muft not be depended on ; for, 
immediately below the joint, the artery divides, like 
that of the upper extremity, into three veffels, which 
are fituated between the bones of the leg. 

" And now — fuppofe a wound to have happened 
by a pen-knife, or other thing, in the thigh, leg, or 
arm, and, a large artery being punctuated, a violent 
bleeding mould enfue— You have no tourniquet, but 
you clearly underftand what has been taught on this 
fubject. — How, then, would you ad? — Undoubted- 
ly you would inflantly pull off your garter, or take 
the firfl piece of firing or cord you could find ; roll 
up your handkerchief hardly, and lay it on the trunk 
of the artery above the wounded part ; pafs the gar- 
ter, or cord, over the handkerchief round the limb ; 
tie a knot, leaving a proper fpace -, and then twill 
the ligature by a piece of flick or cane, or any other 
firm body you could procure." 



BLEEDING. 



The art of opening a vein, and the neceffary cau- 
tions refpeding the operation mould be learned by 
every one j fince cafes of emergency may, happen, 
where the neceffity of its. being performed is evident* 
"k and 



45& MEDICAL ADMONITIONS. 

and where life may be loft before a furgeon can be 
obtained. 

Another qualification neceflary to be pofieffed fo> 
that of being able to flop the flow of blood from a 
vein thus opened. Obvious as are the means to be 
employed on fuch an occafion, I will rifk the afTertion, 
that there is no medical man who has witnefied a 
moderate fhare of practice, but who has met with an 
inflance or two, where, if life itfelf has not been en- 
dangered, considerable injury has been occafioned by 
a wafte of blood, from the orifice opening afrefli, alter 
the departure of the furgeon ; no one of the by- 
ilanders having prefence of mind and intelligence 
fumcient to prevent the farther efFufion. But a little 
attention to a few words will enable any one to per- 
form the office of furgeon in this cafe. 

The fimple principle, with which the mind mould 
be fully pofTefled, is,, that the blood muft ceafe to 
flow, if the orifice be clofed. To accomplish this, 
let the thumb be flid on to the orifice, fo as to bring 
its fides together, ?nd to prefs it with a moderate 
force. The flow of blood will be now flopped, and 
the operator, now confident of the. power he porTeffes, 
with the other hand cleanfes the arm, while a little 
bolder of linen is folded by feme by-ftander, which 
he artfully introduces between the orifice and his 
thumb : over this he places another comprefs, of a 

thicknefs 



MEDICAL ADMONITIONS. 45^ 

tlikknefs fufficient to fill up the hollow of the bend 
of the arm, confining the whole with a ribband or 
tape paffcd over the comprefs, and above and below 
the elbow, in the form of a figure of eight, finifhing 
with a knot over the comprefs. 



LEECHES. 



Leeches may be employed in every cafe where 
topical bleedings are thought necefifary 3 or where 
vensefe&ion cannot be performed. 

As thefe little animals are depended on for the re- 
moval of very dangerous difeafes, and as they often 
feerh capriciouily determined to refrrl; the endeavours 
made to catjfe them i o adhere, I fhall give a few 
directions, by which their afflftance may, with more 
certainty, be obtained. 

This ufeful ally to the phyfician, it may be remark- 
ed, is as little fond of the tafte of phytic as the phyfi- 
cian can be himfelf. The introducing a hand > to 
which any ill flavoured medicine adheres, into the 
water in which they are kept, will be often fufficient 
to deprive them of life ; the application of a fmall 
•quantity of any faltne matter to their ikin, immedi- 
ately occafions the expulfion of the contents of their 
ftomach j and,< what rs mod to our prefent purpofe, 

the 



40fi MEJMCAL ADMONITIONS: 

the Jeaft flavour of any medicament that has been 
applied, remaining on the ikin, or even the accumu- 
lation; of the matter of perfpiration, will prevent them 
from fattening. The Ikin ihould therefore, previous 
to their application, be very carefully cleanfed from 
any foulnefs, and moifteried with a little milk. 

The beft mode of applying them is by retaining 
them to the fkin in a fmall wine glafs, or the bottom 
of a large pill box, when they will, in general, in a 
little time, faften themfelves to the ikin. On their 
removal, the rejection of the blood they have drawn 
may be obtained by the application of fait external- 
ly ; but here, for the fake of thofe to whom we are 
fo much indebted, I fhall remark, that a few grains 
of fait are fuffkient for this purpofe - 9 and that cover- 
ing them with it, as is fometimes done, generally 
deftroys them. It fometimes happens, that the blood 
will continue to flow from the Orifice made by a 
leech longer than is defirable ; and fometimes children 
have been nearly loft from the inability'of the attend- 
ants to fupprefs the discharge. A few words, there- 
fore, defcriptive of the method in which this mould* 
be done, cannot but be ufeful. The blood fhould 
be warned' off clean, and the point of the finger preflT- 
ed- moderately hard on the orifice, when the blood 
wSll ceafe to flow. A fronll comprefs may then be 
applied to the wound, which may be retained by the 
point of the finger, as long as. the blood appears upon 

withdrawing 



MEDICAL- ADMONITIONS. 461 

.wRbdrawing the preffure. Remembering, that no 
xrtore blood need be fuffered to flow, than is thought 
neceffary ; fince all that is required to prevent it, is 
patiently to perfevere in the neceffary preffure. 

SCROFULA. 






e For reafons fufficiently obvious, I (hall not pretend 
to detail the various fymptoms of this difeafe, or to 
lay down a plan of cure. I (hall, with the confidence 
of being much more ufefully employed, point out 
the injury which arifes from neglecting to adhere 
ftriclly to the advice of the furgeon, as to one par- 
ticular circumftance, in the mod dreadful forms of 
the difeafe. 

! 
The curvature of the spine, which is ac- 
companied by a carious ftate of the vertebrae, and 
which, if not timely remedied, is Succeeded by palfy 
of the lower extremities, is a calamity over which the 
furgeon has. fuch confiderable power, as frequently to 
effect a cure, in cafes of a moft deplorable appearance. 
But in hardly any cafe whatever does the furgeon 
more require the auxiliary aid of parental attention. 
and refolution ; fi-ncey let him be ever fo well allured 
©f the effects of the remedies he employs, he cannot : 
exped a favourable: termination of the difeafe, unlefs 

the 



4$g MftfclCAL ADMONITIONS. 

the difeafed parts aie prefer ved in an abfolute ftate of 
reft daring the whole of the cure. Let it be recol- 
lected, that the fpine or back bone forms the grand 
prop or ftay of the animal machine ; that the verte- 
bra of which it is compofed bear the weight of all 
the parts which are luperiof to them ; and that, in 
this difeafe, thefe component parts of this chief flip- 
per ting pillar of the ftructure is in a foft, crumbling 
Hate— Common ienfe will then lay— If you attempt 
a cure, never permit the weight of the body to be 
thrown on the lpongy, diftempered parts, either in an 
upright or fitting pofture, but let the patient be con- 
iiantly kept in an incumbent pofture, on a bed or 
rnattrefs. F:om want oi attention to this injunction, 
as every furgeon knows, the failure of relief in thefe 
cales, may frequently be attributed. 



INFLAMMATION OF THE HIP AND 
KNEE JOINT. 

These dreadful calamities, known by the names 
of Hip Cafes and White Swellings, might frequently 
be prevented, if parents were but aware that they 
may in general be traced back to fome painful affec- 
tion of the part which may have occurred fome weeks 
before any lamenefs was perceived. Painful affections 
of thele parts, therefoie, mould be ferioufty attended 

to, 



MEDICAL APMQNITIpNS, j£* 

tq, as by the early and vigorous employment of appro- 
priate means, the diieafe may t?e removed i|> this, iu 
firft ftage. 

But fhoutd thefe have been neglected, or have bees 
unfuccefsfully employed, dill a cure may be hofjed 
for, but not unlefs, as in the former cafe, the difeafed 
parts are kept conftantly refted. What expectation 
of cure can be entertained, whilft the difeafed part;| 
are forcibly grated together ? Who, to make ufe of 
a homely comparifon, would fet the wheels of a 
watch in motion, whilft in a ftate requiring the Kelp 
oftheartift? 



FRACTURES OF THE LIMBS, AND IN- 
JURIES OF -THE HEAD- FROM " > 
EXTERNAL INJURIES. 



Presuming that the injurious interference of 
domeftic practitioners in thofe cafes which belong to 
this feclion, is not to be expected, I (hall here con- 
fine my admonitions to thofe points which are necef- 
fary to be attended to by the patient and his friends, 
during the Brit moments of the. accident. { 

If, in confluence of a fall from forae high place, 
or by any other accident, a confiderabie degree of 
injury appears to have been received j the fuilerer 

being; 



464 MEDICAL ADMONITIONS. 

being unable, in confequence of the deprivation of 
his ienfes, to point rut the injured part j fome con- 
fideration and attention is neceflary, before any at- 
tempts are made, even to raife him from the ground. 
Should a fracture of one of the bones, either of the 
upper or lower extremity, have happened, and not be 
fufpected by his amftants, their exertions to raife 
him, and to place him on bis feet, might force the 
fractured ends of the bone through the foft parts, and 
convert a mere fimple fracture into a very dangerous 
compound one. The limb^, therefore, with a view to 
this circumflance, mould be carefully examined -> but 
even if they feem to have fuftained no material injury, 
yet fliould the patient not be precipitately raifed, until 
fomething be provided, on which he may be placed : 
as thereby unneceffary, and perhaps injurious, exer- 
tions are avoided. As it will be fair to conclude, 
from the deprivation of the fenfes, that the brain 
may have fuftained fome injury, great care fliould be 
taken, that whilfl he is conveying to his apartment, 
and whilft laying in the bed the head be kept moder- 
ately raifed, and. that on no fuggefticn whatever, any 
fpirituous drinks be given to him. 

The neceffity of the latter caution, from the diffi- 
culty it may occafion in forming an opinion of the 
nature of the injury, will be made evident by the 
following cafe. A lad of twelve years of age fell 

from 



MEJDICAL ADMONITIONS. 4t>| 

from a bay-loft about twelve, feet from the ground,, 
and was brought to his parents about an hour after 
the accident, almoft infenfible : it was with difficulty 
he was roufed to anfwer a queftion, and then immedi- 
ately relapied into a fenfelefs flate, ; after having laid 
in this flate about ten or twelve hours, the furgeon 
firft faw him : he then complained of extreme pain in 
his head, and ficknefs at his ilomach, relapfing be- 
tween whiles into a ftate approaching to infertility,. 

Here appeared to be prefent feveral of the rhoflj 
tcbaracteriftic fyrhptoms of ferious injury to the head ; 
the furgeon 3 thereforej had begun to apprife his 
parents of his apparent danger, when the boy threw at 
little matter off his ilomach, which fmelt ftrongly of 
fpirits. He was immediately well drenched with 
warm water, until what he rejected no longer fmelt of 
fpirits. He then fell afleep, and awoke perfectly well 
in a few hours, the brain having fuflaihed ah injury, 
not from the fall, but from a bumper of brandy, 
which had been given to him by one of the by -flank- 
ers, as a cordial^ when he was firft taken up. 

> But mould it be difcovered that a leg or thigh is 
broken, the aid and directions of a furgeon thould, if 
poffible, be obtained, for his removal j but if this 
cannot be the cafe, the following rules fbould be 

obferved; 

, ... - • ; 

Lil %. That 



466 MEDICAL x\DMONITIONs: 

i. That he be not ftirred until a proper vehicle 1* 
procured, on which he can be placed. 

2. This, if nothing more proper can be had, may 
be a door, a mutter, or two or three planks well fe- 
cured together. 

3. To place him on this, two perfons may raife 
him, by means of a iheet Hid under his hips, whilft 
one or two raife him by the flioulders ; one perfon 
railing the found leg, and one, the mod intelligent of 
his friends, conducting the fractured limb. 

4. In moving the fractured limb, the object which 
mould poflefs the mind, ihould be, that the divided 
pieces of the bone be kept as much as pofiible in the 
fame line, left the fractured ends pierce through the 
foft parts. 

5. If a pillow can be obtained, the broken limb 
mould be placed on it ; and, if it appear to be pre- 
ferable, previous to his being raifed. ' 

6. When placed on the litter, he mould be a little 
inclined to the fame fide of the injured limb, which, 
if circumftances will admit, mould alfo be laid on 

the fide, and with the knee a little bent. 

f 

7. The bef! mode of conveyance is undoubtedly 
by two or four men, in the manner in which a fedan 
chair is carried. A cart, or even a coach, fhould 

never 



MEPICAL ADMONITIONS. 467 

never be employed, where the mode juft recommend- 
ed can be adopted. 

8. As the patient will be under the neceflity of 
laying fome time without getting up, a matrafs fhould 
be laid on his feather-bed, or, if that cannot be had, 
two or three long and wide boards, joined together, 
maybe placed under the feather-bed. If this can 
be done before he is firfl laid down, much fubfequent 
pain and exertion will be prevented. 



If the arm be broken between the elbow and the 
wrift, the arm fhould be bent at the elbow, railing the 
palm of the hand to the breaft, with the fingers 
moderately bent ; the thumb being fuperior, and the 
little finger inferior. In this ftate it may be retained 
by a fling or handkerchief, fupporting it from the 
elbow to the fingers ends. 

When the arm is fractured between the wrift and 
moulder, the fore arm may be placed in the fame 
pofition as already defcribed y but the fling, inftead 
of fupporting the whole length of the arm, fhould 
only fupport the hand, which fhould be raifed higher 
than in the former cafe, the elbow being allowed to 
link ; its motion, however, being prevented, by a 
handkerchief paffed moderately tight round the trunk, 
including the fractured arm; 

I HERE 



468 MEDICAL ADMONITIONS. 

I here conclude the talk allotted mc, hoping that, 
notwithstanding its imperfections, this little work may 
prove of real utility. ' 

Your candour will, I truft, prevent you from in- 
ferring from my philippics againft domeftic quackery, 
that it is my wifh to leffen the diffufion of ufeful 
knowledge. Indeed, on the contrary, I am confident 
that the beft, and moil: effectual mode of checking 
the career of empiricifm would be, by more frequent- 
ly admitting the fludy of anatomy, phyfiology, patho- 
logy, and chemiftry, as part of a liberal education. 

PofTefTed of fome knowledge of the ftructure, of 
the ufes, and of the laws of action, of the various parts 
of the human' body ; and apprifed of the confiderable 
difference between difeafes of fimilar appearance, few 
could be difpoied, except where error feemed impof- 
fible, to prefer! be for themfelves, and lofe the advan- 
tage of that aid which they might expect from thofe 
who had palled their lives in the fludy of the healing 
art. In farther recommendation of the ftudy of thefe 
fciences, I muft obfeive, that, independent Of the ad- 
vantages juft mentioned, anatomy and chemiftry 
would furnifti the inquifitive mind with the moft 
curious and interefting facts ; and would prove a 
fource of rational and inftructive entertainment. So 
cbvious, indeed, is this, as to render it furprifing that 

gentlemen^ 



MEDICAL ADMONITIONS. %6tJ 

f entlcmen, not of the profeffion, fhould not more 
frequently avail themfelves of the opportunities of 
acquiring this kind of knowledge, in the pleafant and 
expeditious manner in which it is offered them, by 
the public lectures on thefe various branches of fci- 
ence. Nor is fo much previous knowledge. neceffary 
as is in general fuppofed, the perufal of Dr. Gregory's 
(Economy of Nature, and of the Medical Extracts, 
would fupply all the information necefiary to render 
the comprehension of the doctrines laid down in fuch. 
lectures perfectly eafy. 

To thofe who may wifh to obtain more accurate 
^knowledge reflecting diet and regimen, the lectures, 
published on thefe fubjects, by Dr. A. F. M. Willich 
will be found highly ufeful. And it is with pleafure 
I ftate, that very ample directions to nurfes for the 
management of the fick, in thefe refpects, may be 
expected foon from Dr. Hamilton, Phyfician to the 
General Difpenfary. 

From a fear left what I have faid againft indifcrect 
attempt to harden children, as it is termed, fnould 
not appear fumciently convincing, I cannot refrain 
irom earneftly recommending to parents the perufal 
of Dr. Darwin's excellent Effay on the Education of 
Females- 



As 



47° MEDICAL ADMONITIONS. 

As the exemption from the fmall-pox by the inocu- 
lation of the matter of the cow-pox, may Hill be con- 
fidered as a fubject of experiment and mveftigation,it 
cannot with propriety be dwelt on in a work of this 
kind. The farther experiments of Dr. Jenner and 
Dr. Pearfon, with thofe which, I truft, will enrich 
the fecond volume of Dr. Woodville's excellent 
Hiflory of Inoculation, will, I hope, clearly fhew how 
much may be expected from this moft important 
difcovery. 

I am, 

Your's, 

J. P, 



OBSERVATIONS 



o- 



OBSERVATIONS 

ON THE,' 

Excejfive Indulgence of Children ', 

PARTICULARLY INTENDED TO SHOW- 
ITS INJURIOUS EFFECTS ON. THEIR HEALTH, 

AND THE 

DIFFICULTIES IT OCCASIONS IN THEIR. .TREATMENT 
DURING SICKNESS. ' 



Theft ftall the fury paffior.s tear, 
The vultures of the mind ; 

Difdainful anger, pallid fear, 
And fliame that fkulks behind^ 



A 



SLIGHT and tranfient view of the duties of 
parents to their children, during the fiat e of infancy y \ 
might favour the opinion, that little more is required 
of them than that care for their prefervation which 
the brute parent inftincYively bellows on its offspring. 
But when it is confidered that the human parent 
poffefTes reafoning powers, and that the mental ener- 
gies of the child begin to be evolved in the early 
days of infancy, it muft be obvious that the duties 
are much more numerous and much mure important : 
Vol. II. of 



472. M£DICAL ADMONITIONS* 

Of a degree of importance indeed proportioned to trMj 
elevated place a child pofTefles in the fcale of animated 
beings. Nor is this obfervation unneceffary j no 
caftle is here creeled merely for the purpofe of being 
levelled ; fince there are too many inflances where the 
minds of children are no more attended to, than if 
they were really the offspring of brutes ; and where 
even the necerTary care for their health and exiiience 
is exceeded by almofl the whole of the brute creation. 

That children are born with various difpofitions is 
undoubtedly true - } but it is alfo true, that by due 
management, thefe may be fo changed and meliorated 
by the attention of a parent, that not only little blem- 
ifhes may be fmoothed away ; but even thofe circum- 
flances which may more offenlively diftinguifh the 
child* may, by proper management, become the 
chara&eriftic ornaments of the man. But, alas ! too 
often do we fee, from the want cf this care, the charm- 
ing blofToms of virtue and happinefs .blighted. 

On the treatment the child receives from his parents, 
during this flage of his life, will, perhaps, depend 
much of the miiery or happinefs he may experience, 
not only in his palTage through this, but through the 
other iiages of his exiiience. If, on the one hand, 
every little Tally of pailion and impatience is immedi- 
ately controuled ; if that which is admiffible is regu- 
larly permitted, and that which is improper as regu- 
larly 



MEDICAL ADMONITIONS* 473 

forty withheld, the wily little creature will foon learn 
to diftinguifti that which is allowed of, from that which 
is prohibited. He will* indeed, urge his claim, for 
that to which he has been taught he has a right, with 
manly boldnefs ; but will not harafs hjmfelf and his 
attendants, with ceafelcfs whinings or ravings, to ob- 
tain that which uniform prohibition has placed beyond, 
expectance. But a melancholy reverfe appears, if, on 
the other hand, no confiflency is obferved in his 
management j if, at one time, the flightefr indulgence 
is refufed, and at another the moft extravagant, and 
even injurious cravings, are fatisfied, juft as the caprice 
of the parent may induce him to gratify his ill hu- 
mour, by thwarting another ; or to amufe his moments 
of ennui, by playing with his child as a monkey, and 
exciting it to thofe acls of mifchief and audacity for 
which, in the next moment, it may fuffer a fevere cor- 
rection. Continually undergoing either difappoint- 
ment or punifliment ; or engaged in extorting grati- 
fications, which he often triumphs at having gained 
by an artful difplay of paffion ; his time paries on, 
until at laft the poor child manifefts ill nature fufficient 
to render him odious to all around him, and acquires 
pride and meannefs fufficient to render him the little 
hated tyrant of his playfellows and inferiors. Can 
the duties of a parent have been fulfilled in this cafe ? 
Can the child owe any duty, in return for fuch con- 
duel: ? Certainly not. What may be the natural 
M m ra obligations 



474 MEDICAL ADMONITIONS. 

obligations of a child to a parent is not intended to 
be here dwelt on, it is only meant to be aiTerted, 
that they muft be lefTened by treatment Co abfurd 
and injurious. 

The mortifications which the parent muft repeated- 
ly endure, from perceiving his darling child render 
himfelf obnoxious to all around him, by the enormity 
of his conduct, muft awaken a lufpicion that fome 
error has been committed in his management ; and 
muft, at times, excite a tranfient inclination to adopt 
a more firm and rational mode of conduct. But fup- 
pofe this child of humour and indulgence to be over- 
taken by llckncfs, then muft the unhappy parent find 
conviction ftafh ftrong on his mind, and he becomes 
his own harfh, unforgiving accufer. When life itfelf 
depends on a peaceful ferenity, and an exact compli- 
ance with various regulations, he fees his froward 
darling fevered by the exertions of paflion ; and ex- 
haufted by petulant rejections of the means of relief, 
and by inceffant cravings for thofe things which, being 
noxious, are prohibited, and which, by the perverfenefs 
of temper, are thereby rendered more defirable. 
Generally does the poor little fufTerer pay with his life 
the purchafe of his early indulgencies ; or, at beft, 
efcapes with an enfeebled conftitution, prefenting a 
conftant memorial to his parent, that — the temper 

OF A CHILD IS FORMED IN TH£ EARLY DAYS OF 
INFANCY. 

Every 



MEDICAL ADMONITIONS. 475 

Every one who has had opportunities of obfervation, 
muft have remarked how diftreffingly the fufferings of 
the child, the perplexity of the phyfician, and the 
diftrefs of the parents are augmented by frowardnefsof 
difpofition. To particularife the various injuries 
which the exceffive indulgence of the caprices of chil- 
dren may occafion to their health, and the feveral 
impediments it is productive of to their proper treat- 
ment, when opprefled with difeafe, (hall be the en- 
deavour of the fucceeding pages. _ In making this 
attempt, it is eagerly hoped, that very powerful 
arguments will offer themfelves to the affectionate 
parent, in favour of a ftri& regulation of the difpofi- 
tions of children, even during their early infancy. 

The difeafes of children are, in general, involved 
in fo considerable a degree of obfcurity, as to demand 
the exercife of much ingenuity, and acutenefs of dif- 
crimination in the phyfician, whilft engaged in difcov- 
ering the nature of the difeafe he is required to remove. 
But when his enquiries are impeded, by exceffive 
wailings ; when the expreffions of impatience magnify 
one particular fymptom, and conceal the reft j the 
niceft invefligation may prove infufficient to obtain 
the necefiary information. 

Not only is the phyfician fometimes, thus prevented 
from forming a juft opinion of the nature of the dif- 
eafe j but even when, by dint cf earneft attention and 

enquiry, 



476 MEDICAL ADMONITIONS. 

enquiry, he has fatisfied his mind j and is difpofed to 
employ thofe means which his judgment may dictate, 
it too frequently happens that infuperable difficulties 
arife of another kind. The medicines he fhall pre- 
scribe, he will, very likely, be told, muft not only not 
be ill-flavoured, but, if he expe&s they (hall be gotten. 
down his patient, they muft be abfolutely without 
any tafte. 

In thofe cafes, in which bleeding by leeches is re- 
quired, he will often be told that however neceffary 
their application may be, it is a remedy which muft 
be declined ; for mould the child ever fee them, he 
would be immediately thrown into convulfions ; and 
as to a blifter, although they, the parents, might be 
difpofed to fubmit to have their child expofed to the 
infliction of this torture ; they are fatisfied that as 
foon as he mould experience pain from its action, he 
would directly tear it off. Placed under fuch limita- 
tions it cannot be expected, however anxious the 
phyfician may be to procure relief to his patient, that 
much advantage can be obtained by his prefcriptions. 
He therefore, either declines his attendance ; or acting 
within the bounds to which he is limited, he does 
little more than alleviate fome of the more diftreiTing 
fymptoms, whiift he has the mortification to witncfs 
the alm'cfl uninterrupted pronrefs of the difeafe. 

: 

Thofe. children who are allowed to conduct them- 

felves, 



MEDICAL ADMONITIONS. 477 

felves, entirely as their humour happens to prompt 
them ; and who have unhappily been taught, by 
their parents' imprudence, to regard their d. dates as 
nugatory j are not only more expofed to the attacks 
of difeafe ; but have the chance of its removal leffen- 
ed by not allowing the employment of the rnoft 
efficacious means. Frequently, alfo, iheir diibrder is 
augmented, by the violent exertions confequent to 
the irritation of the mind, pruduced by the pain, and 
the various inconveniences, accompanying the flace of 
difeafe. 



IMPROPER INDULGENCES. IN FOOD. 

Unlimited indulgence of children in the article 
of food, is a fource from which a multitude of difeafes 
.arife.' The child is placed at a table, where variety 
of meats, and the ingenuity of the cook, tempt the 
flomach to take food, beyond the calls of natural ap- 
petite. From extreme kindnefs, he is helped from 
almoft every difh, until the ftomach has received fo 
much as to occafion an injurious diftenfion of its coats, 
in confequence of which, the performance of digeftion 
is confiderably impeded. 

This procefs being daily repeated, probably, the 
digeflive powers become fo much impaired, that lofs 
of appetite, fqueamimnefs, and even frequent vomit- 
ings 



478 MEDICAL ADMONITIONS. 

ings fucceed. The child, inflead of acquiring ftrength, 
evidently becomes weaker, the eyes appear funk, the 
complexion aflumes a waxy palenefs, and fo great a 
degree of emaciation takes place, as plainly (hows, that 
but little nourifhment is derived from the great quan- 
tity of food which is employed ; and that the kindly 
meant indulgences have produced effects, directly op- 
pofite to thole which were intended. 

But mould even thefe effects not take place, to the 
degree here defcribed, and the flomach efcape this 
fpecies of injury j an evil of another kind, of no fmall 
magnitude, will very probably occur. In confequence 
of thefe repeated diftenfions of the flomach, its capa- 
city becomes actually enlarged, and the habit of 
•taking large quantities of fond is induced. Although 
the appetite becomes fo depraved as to demand the 
confumption of even an enormous quantity of food, 
the flomach, however, not having its faculties increaf- 
ed, in the fame proportion as its capacity, the fyflem 
does not derive, even the fame quantity of nutriment, 
as is afforded by the ordinary quantity of food, acted 
en by a flomach in its natural (late. Hence will it 
be often feen, that children who feed even rapacioufly, 
are thinner, and have a lefs healthful appearance than 
tliofe, who k^d with more regularity and moderation, 

From thefe inordinate gratifications, another disa- 
greeable circumftance frequently arifes : as the child 

experiences 



MEDICAL ADM0NITI0N5. 47.9. 

experiences a lofs of appetite for proper food, he be- 
comes fubject to the moft unnatural cravings. The 
ftomach fatiated, and even forfeited, with fweets and 
delicacies, folicits for fubftances which are, to others, 
the moft fordid and difguftful. 

The foundation of all thefe evils is often laid in th£ 
firft months of the child's life, by repeatedly diftend- 
ing its ftomach with the various mixtures, employed 
as fubflitutes for that food which nature has prepared 
for it, and, of which it never fuffers a deprivation, 
without danger of the moft diftrefsful confequences 
enfuing. 

In early infancy, therefore, where unhappily the 
child is obliged to fubmit to this cruel deprivation, 
the food which is fubftituted mould be Ample, and 
approaching as nearly as poffible to the nature of 
the mother's milk. Goats milk, afles milk, and cows 
milk are probably the beft fubflitutes ; but thefe 
fhould be given frefhly drawn from the animal, {light- 
ly warm, unmixed with vegetable fubftances, and in 
frequent, but moderate quantities. Too frequently 
is the paffive infant feen laying acrofs the lap of its 
Uurfe, who pours into its ftomach, one boatful after 
another, as warm as it can be fwallowed, a mixture 
of water thickened with bread, the acefcent fermenta- 
tion of which is promoted by the addition of fugar, 
this being often allowed to begin to take place, in the 

fpace 



480 MEDICAL ADMONItlOU*. 

fpace of time between its being mixed, and its being 
given to the infant. 

As the child advances in age, frill muft it be remem- 
bered, that its health will depend on the fimplicity of 
its diet. The variety in its chief meal mould never 
be extended beyond two dimes ; the one, confifting 
of vegetables, drefled in the moft fimple mode, or of 
fruits drefled in the form of pudding or pie ;• and 
the other, of animal food drefled as plainly as poilible. 
Pickles and fpices mould be entirely avoided. 

When this is dove, and children are not teized 
with repeated urgings, to try to take a little bit more, 
they wiii be ieldom roui.d to eat inordinately ; or to 
lejcct capiirioufly that food which is fitted for them. 
Id thole cafes, where either of thefe circumftances oc- 
curs, it will, in general, be found to depend on injuri- 
ous habits, induced by thofe improper modes of 
feeding, during infancy, which have been jufl par- 
ticularifed. 

NERVOUS 



• This permifTion will to fome appear objectionable, as 
paftry has been repeatedly declared to be among thofc articles 
of food which are moft injurious to the ftomach. But al- 
though this may be true of thofe kinds of paftry which are 
made to contain a large quantity of butter, it docs nor fecm 
that pie-cruft of the plainer kinds can be fo hurtful as to 
authorife its prohibition. 



MEDICAL ADMONITIONS. 48 1 

NERVOUS AFFECTIONS, AND MADNESS. 

Those parents will often find themfelves egregi- 
ouily deceived, who Hatter themfelves into a confident 
expectation, that the early indulgence of the humours 
and caprices of children, will not be fucceeded by any 
injurious confequences 3 and that, as they advance in 
years, reafon will aflume her empire, and correct every 
improper propenfity. But when the period arrives at 
which the reafoning powers are, in general, ftrong, it 
will, too frequently, be found that the pafiions have, 
by long indulgence, become flrengthened, and are 
too turbulent to fubmit to the dictates of reafon. 

When the child of indulgence attains this period-, 
judgment, ill formed, and exercifed only by ftarts, 
ferves merely to chequer his actions with inconfiftency 9 
whiifl reflection torments him, by mowing to him 
the folly and extravagance of paft conduct, and by 
pointing out to him as his duty, the adoption of that 
path into which he is unable to enter, fince inclina- 
tion, the abfolute directrefs of all his actions, leads him 
the contrary way* 

Accuflomed to yield to no oppofition, and taught 

that the bufinefs of life is not to endure, but only to 

enjoy j he is but little able to brook thofe rubs, which, 

in the ordinary courfe of things, jnuft fall to his lot. 

N n n Every 



4&2 MEDICAL ADMONITIONS. 

Every circumftance which tends in the leafl to dimin- 
ifh the confequence he afiumes, is felt mod poignant- 
ly ; and from this principle, even the fuccefTcs of thofc 
around him yield him pain. 

When he mixes with the world, he is mre to find 
thofe of a fimilar difpofkion with his own, who will 
be ready to harrafs and thwart him at. every turn - y 
whilft others, who know the facility of overreaching 
one who is full of confidence in his own judgment, 
but who, at the fame time, bends like a reed before 
the breath of adulation,, will not fcruple to accommo- 
date themfelves to his humours, the more eafily to 
cajole him, and render him their dupe. 

It having been hitherto the employment of thofe 
around him, to fhield him from the mortification of 
difappointment, by procuring the exact correfpon- 
dence of events with his wiflies, he comes into a trick- 
ing world, with a dangerous confidence of expectation 
and hope. His mind dwells with a deceptive ,afTu- 
rance of fuccefs, on the termination of every fpccuiative 
fcheme ; and failure feems, to him, to be impoffible. 
Thus deceiving himfeif, he looks forward only for fun- 
fhine ; and makes no preparation for thofe florms, 
againfl which, thofe bleft with more caution carefully 
guard. When difappointment does break upon him, 
every thing confpiresto render his diftrefs moft pungent 
and intolerable. His fphere cf dominion, as it were, 

is 



MEDICAL ADMONITIONS^ 483 

is contracted. As his expectation of increafed fuperi- 
ority has been indulged, the dread of humiliating de- 
preffion is augmented. The fuffering mind foon 
marks its influence on the whole nervous fyftem : 
his nights are palled, almofl without fleep ; his ap- 
petite, and confequently his ftrength, foon fail him ; 
and not only is the Stomach impaired, but the bowels 
alfo become difordered. Frequent head-ach, tre- 
mors, palpitations of the heart, and dejection of fpirits 
foon follow ; until his mind, morbidly irritable, is 
constantly tormented with imaginary evils. Every 
action of thofe he made feel his fuperiority, .whilft 
profperity bewildered him, feems now to be intended 
for retaliation : and even the manifestations of com- 
panion are regarded by him, as the molt cruel of all 
infults. Thus fuffering under an accumulation of 
real and fancied ills, his mifery becomes fo great and 
infupportable, that fullen or furious infanity, or dread- 
ful fuicide may foon be expected to fucceed*. 



EPILEPTIC FITS. 



The fondly indulgent parent muft alfo be inform- 
ed, that long before the age of maturity, the brain 
may become ferioufly affected in confequence of thofe 
paffionate exertions which unlimited gratifications 
teach an infant to difplay. 

"The 



484 MEDICAL ADMONITIONS. 

The child who is accuftomed to conftant fubmif- 
lion from all around him, feldom experiences oppo- 
iition to his moft extravagant and dangerous requefts, 
without manifefting his refentment by the moft violent 
and outrageous fits of pamon. To thefe may frequent- 
ly be attributed the occurrence of epileptic fits, and 
other convulfive affections, which often continue, 
through life, the dreadful lot of the fubject of indif- 
criminate indulgence. 

A remarkable inftance of epilepfy being thus pro- 
duced, and of its cure, I once witnefTed in a girl about 
feven years of age. The leaft refiftance to the willies, 
of this. little favourite was almoft fure to be followed, 
by the moft violent gufts of paffion, which generally 
terminated in an epileptic fit. After applying for 
relief to feveral phyficians, and employing, without 
the leaft appearance of fuccefs, every meafure which 
had been recommended - 3 although, perhaps, not with 
lb much regularity and perfeverance as the cafe re- 
quired, her parents concluded the difeafe to be in(u- 
perable, and declined any further attempts at a cure. 

At this period, a friend recommended a remedy, 
which he afferted would, if employed with a ftrict 
attention to every circumftance enjoined in the pre- 
fcription, infallibly effect a cure. The prefcription 
was as follows : — 

Take 



\ MEDICAL ADMONITIONS. 485 

Take two ounces of blood, about the time of the 
moon becoming full, from the arm of the 
patient, and ftir into it a tea fpoonful of fait. 
This mixture muft be fwallowed whilft ftill 
warm. If the patient experiences any return 
of the fits, the bleeding muft be repeated, and 
the blood again drank on the ninth morning, 
mixed with the fait as before. 

The blood was taken away, and the horrid potion 
drank ; but neither the one nor the other was accom- 
plifhed, without exciting in the unfortunate fubject 
of the experiment the flrongeft figns of repugnance 
and horror. Indeed, the experiment would not have 
been made, fo great a degree of averfion was manifeft- 
ed by the patient, had not the parents placed great 
reliance on a remedy which, beiides being fo ftrongly 
recommended, was by its uncornmonnefs, and by the 
attention required to be paid to the ftate of the moon, 
and to certain days, well calculated to infpire an ex- 
traordinary degree of expectation. Complete fuccefs 
was the reward of their refolution, for not only was 
the return of the fit prevented ; but a moil unexpect- 
ed event took place, the child was no longer prone to 
thofe violent gufts of pafEon to which fhe had hither- 
to been fubjecl. 

To account for the operation of this extraordinary 
remedy is, perhaps, not very difficult. With the 

hope 



4-86 MEDICAL ADMONITIONS^ 

hope of inducing the child to reprefs its violent failles 
of pafiion, the dependence of the fits on thefe had been 
frequently and ftrongly inculcated -, and well knowing 
that thefe means were employed to prevent the return 
of the fits, and that they were again to be repeated 
fhould the fits return j the child could not avoid 
making the conclufions, that to avoid this terrific and 
difgufting procefs, it was abfoluteiy necefiary that fhe 
fhould reprefs her pafftonate exertions ; and that it 
tvas much better to fubmit to the will of her parents, 
than be again forced to fvvallovv her own blood. 



RUPTURES. 

Among the caufes of ruptures, in children, may be 
undoubtedly mentioned, the exertions which accom- 
pany violent fcreamings and crying. This is a fact 
which muft be fo well known, as to require to be 
mentioned only, for the fake of reminding the fond 
parent, that this complaint, which may continue 
through life, is very likely to be one of the melancholy 
confequences of that violence of temper which ex- 
treme indulgence too often creates. But even without 
considering the exertions juft mentioned as equal to 
the effect of producing this malady,* the impediments 
they will place in the way of a cure are fo considerable, 
and {o obvious, as to demand but very little reflection 

to 



MEDICAL ADMONITIONS. 4$^ 

to convince the parent, that, in this cafe, no tempo- 
rary gratification can atone to a child, for the pain 
and inconvenience to which he is thus fubje&ed. 



FRACTURED LIMBS. 



When a child, who in temper and difpofition is 
rather intractable, has the misfortune of fuffering 
under this accident, the pain and inconveniences lie 
will endure muft be confiderably greater than thofe 
of a patient, in whom conformity to the injunctions 
of the furgeon, and fubmillion to the Decenary con- 
finement and reltraints can be obtained. In the one 
cafe, nature proceeds uniformly and regularly to the 
completion of that procefs, by which the bone is 
united : the parts being fo retained by the art of the 
furgeon, and the attention of the patient, that the 
union is generally accompli (lied, without injury either 
to the functions, or the appearance of the injured 
limb. But, in the other cafe, where the injunctions 
of the furgeon are not obeyed by the patient ; and 
where, yielding to impatience, he is conflantly moving 
the injured limb, nature is interrupted in her work, 
and the utmoft care of the furgeon may be infuhicient 
to prevent his patient from fullering from deformity 
and lamenefs, through the remainder of his life. 

FEVERS 



4oS. i MEDICAL ADMONITIONS. 

FEVERS IN GENERAL. 

In fever, and indeed, in every febrile complaint, 
the want of iufficient influence over children to obtain 
a compliance with neceflary regulations, may be con- 
fidered as a circumftance likely to place them in a 
fituation of great danger. 

In the commencement of fever, when its fpeedy 
cure, or its tedious protraction, will depend on the 
almolr entire removal of external irritation, and on 
obtaining a copious flow of perforation, the hopes of 
the phyfician will be proportioned to the degree of 
fubmiffion he difcovers in his patient, whofe continu- 
ance in an irkfome and unpleafant fituation, for feveral 
hours, mud often be required. If the body is not 
kept flail, and the arms, and even, perhaps, the face, 
are not kept underneath the bed-clothes ; and if 
proper drinks are not taken freely, and of a due degree 
of temperature, little chance will exifl of any benefit 
being derived from the remedies employed. But in 
thofe children, whom faulty indulgence has rendered 
too irafcible, the neceflary fubmiffion is with difficulty, 
if even at all obtained. As the heat and inconveni- 
ences increafe, fo alfo will the agitations of the child 
increafe : the body will be thrown from one fide of 
the bed to the other, and the arms continually toiTed 
out of the bed ; the head ach at the fame time being 

augmented 



MEDICAL ADMONITIONS. 489 

augmented by inceffant waitings, and the oppofition to 
thofe injunctions to which he is not difpofed to fubmit, 

As the difeafe proceeds in its progrefs, the difficulties 
arifing from want of a due government of the child 
will be found to increafe. Medicines, and thofe, of 
neceffity, not very pleafant, fhould be taken ; drinks, 
not exactly of that degree of temperature, nor quite 
agreeable to the tafte of the patient, may be required 
to be drank ; and oftener, perhaps, than he is inclin- 
ed to. A quiet fubmiflion to all this might be too 
much to expect in almoft any child ; and in a child 
who has not been habituated to fubmit to the dictates 
of its parents, his oppofition will, mod probably, be 
fuch as to prevent the neceflary means from being 
employed with the leaft probability of fuccefs. 



INFLAMMATORY AFFECTIONS IN 
GENERAL. 



Indulgence in too high living, by taking too 
freely of animal food, of highly fealoned dimes, and 
of wine, frequently creates, in children, a difpofition 
to difeafes of the inflammatory kind. 

Were the operations of inftinct allowed to direct a 

child in the choice of its food, this fpecies of excefs 

would but rarely happen ; but unhappily parents, led 

away by fanciful reafonings refpecting the food of their 

O o o children., 



49<=> MEDICAL ADMONITIONS. 

children, often vitiate their tafte, and overpower the" 
impulfes of inftind, by intruding on them that kind 
of diet which is oppofite to that which nature de- 
mands. Frequently, thinking that a child cannot be 
too highly nouriihed, will a fond mother be feen urg- 
ing a fine, full, healthy child, to eat more meat, whilft 
the child turns with difguft from the morfel which 
is forced upon him. 

In fuch a cafe, either the inftin&ive appetite of the 
child will prevail, and his difrelim for animal food will 
be increafed, by its being repeatedly forced upon him 3 
or, in confequence of perfeveringly continuing to 
oblige him to take animal feed, the flomach becomes 
ib far accuftomed to the meal, that he, at laft, eagerly 
craves, with a depraved appetite, for that food which 
he before rejected. In this way may be brought on 
the habit of taking animal food beyond the demands 
of the fyftem, by which confidtrable danger will arife, 
of fuch a difpofition to inflammation enfuing, as may 
require only a very flight occafional caufe to produce 
a dileafe, of a very alarming nature.* 

THE 

* It is proper to obferve here, that parents fometimes run 
into an error of an oppofite kind ; but, perhaps, not lefs in- 
jurious to their children. Alarmed by fome little appear- 
ances of eruption or fcurfinefs of the fkin, they fufpeft fome 
particular grolTnefs of the humours, and, with the hopes of 
correcting this fiate, the child is flridly prohibited from 
taking any animal food, butler, &c. fuch a regimen being 

infifted, 



MEDICAL ADMONITIONS. 49 1 

THE CROUP. 



Without dwelling on the poflibility of this dread- 
ful difeafe being actually produced, by the long con- 
tinued and violent fcreamings, which children, who 
have been much humoured, fometimes employ to 
obtain thofe things of which they are defirous, or to 
manifefl their diflike to thofe things they wifh to 
avoid, it may be fufficient to remark, that this difeafe, 
always formidable, will hardly ever yield where the 
unhappy fufferer is of a petulent and froward difpo- 
fition. 

The frequent fcreamings by which children of this 
defcription manifefl the diftrefs they endure, cannot 
but increafe the inflammatory ftate of the windpipe ; 
befides that the reflleflhefs, and frequent agitation of 
the limbs, mufl entirely prevent that ftate of the fkin 
from being produced, on which the cure will materi- 
ally depend. i 



INFLAMMATION OF THE LUNGS. 



This inflammation of the lungs becomes, in fuch 
fubje&s, a difeafe truly formidable. The poor little 

fufterer, 

infifted on, confiding of puddings made without eggs, dry 
bread, milk thinned with water, &c. as cannot but increafe 
that debility which already too much prevails. 



492. MEDICAL ADMONITIONS. 

fufferer, to whom the patient endurance of even 
trifling inconveniences has not yet been taught, will 
mod probably, under the didrefsful fenfations accom- 
panying this difeafe, employ exertions fo violent, as 
may be likely to augment every alarming fymptom. 

By fuch incefTant agitations, the heat of the blood 
is increafed, the circulation is hurried on through the 
inflamed lungs, the perfpiration is checked, and the 
febrile date is neceflarily increafed. 



PLEURISY, 



The remarks jud made mud apply with dill more 
force, in cafes of pleurify, the urgency of the pain 
neceflarily occafioning, even in the mod patient, that 
degree of agitation which mud confiderably counteract 
the meafures employed to effect the cure. 



INFLAMMATION OF THE STOMACH 
AND BOWELS, 



In this difeafe, where the agonies of the patient 
are fo vehement, the mod patient fufferer will hardly 
poffefs the power of reprefling his exertions, fo as to 
give to the remedies employed thofe advantages which 
are neceflfary for fecuring their effectual operation. 

Much 



MEDICAL ADMONITIONS." 493 

Much lefs mull it be expected then from thfrpoor 
Child who has been permitted, and even taught to 
difplay his refentment and anger upon every inciden- 
tal infli&ion of pain. 

Children who are unlimitedly gratified with every 
thing they capricioufly demand, may alfo be reafona- 
bly expected to be more prone than others to this dif- 
eafe. The various articles of indigestible train, which 
fuch children are conftantly taking into their ftomachs, 
mull, by the irritation they occafion to the bowels, be 
likely to produce this difeafe. 



INFLAMMATION OF THE EYE, AND 
EYE LIDS. 



The termination of this difeafe, in children, will 
frequently depend on the degree of docility with which 
the little fufTerer is endued. When he is unhappily 
of an untoward difpolition, a diflrefsful termination 
may be apprehended. The inflamed eye, from which 
every flimulus fhould be abltracted as carefully as 
poffible, is by fretting kept continually fuffufed with 
briny tears. To be convinced how much injury this 
mull occalion, it is only neceffary to recollect, that 
rednefs and tendernefs of the eyes and eyelids are ef- 
fects which always fucceed to this mode of expreffing 
diftrefs. Children who are not under due restraint, 



494 MEDICAL ADMONITIONS. 

will alfo always confiderably aggravate the evils under 
which they fuffer, by conflantly rubbing the inflamed 
eyejwith their hands -, a practice which children of 
this defcription generally have recourfe to, expecting 
thereby to remove the pain and inconvenience they 
fuffer. In addition to thefe circumftances it is to be 
confidered, that in children of the defcription of 
which we are fpeaking, the greateft difficulty exifts in 
obtaining the employment of the neceffary means of 
cure. Not only is the furgeon perhaps prevented, 
from adminiflering proper internal remedies ; but he 
is alfo moft certainly precluded, from having the ex^ 
temai applications duly employed. 

These are impediments to the cure of this malady, 
in children of a violent and petulant temper, which 
every furgeon muff, have had reafon lepeatedly to la- 
ment. Indeed, I doubt not but that all thole who 
have had the opportunities of obfervation, will concur 
with me in thinking, that blindneis is, in thefe cafes, 
not unfrequently the confequence of parents lofing, 
by their mifmanagement the neceffary fway over the 
minds of their children. 



l 



THE MALIGNANT, ULCERATED, 
SORE THROAT. 



Life mull frequently depend, in the malignant 
ulcerated fore throat, on the degree of compliance and 

manageablenefs 



MEDICAL ADMONITIONS. 495 

manageablenefs which the little patient evinces during 
its progrefs. Meafures are necefTary to be adopted 
in thefe cafes which muft not only be difagreeable, 
but which are productive of an increafe of fuffering, 
for a time. Nutritious drinks, although occafioning, 
by the mere action of fwallowing, confiderable pain, 
muft be taken freely, or the ftrength of the child will 
not be fufficiently fupported. Wine, which from its 
fharpnefs muft occafion ftill more pain in being fwal- 
lowed, muft alfo be occafionally employed. Prepara- 
tions of bark and other medicines, not perhaps agreea- 
ble to the palate, muft in moft cafes be required ; and 
gargles, from the ufe of which fome inconvenience, 
and even fome pain muft arife, will often be indifpen- 
iibly necefTary. 

But when the unhappy fubject of this difeafe has 
been in the habit of permitting that only which ac- 
cords with his inclination, and of obtaining an exact 
fubmiffion to all his little caprices, little hopes can be 
entertained, if the cafe be dangerous, of any real ad- 
vantage from medical advice of even the higheft 
eftimation ; fince in a child thus educated, no hopes 
can be entertained, that fuch a compliance with the 
prefcriptions will be obtained as will give a chance of 
its recovery. 

THE 



49^ MEDICAL ADMONITIONS! 

THE HOOPING COUGH. 



In the hooping cough, the paroxyfms are always 
likely to be brought on by any pamonate exertions. 
A confiderable difference is always to be perceived, in 
the number of the paroxyfms in the fame child, on 
thofe days in which but little has occurred to ruffle its 
mind ; and on thofe days, when fome little oppofition 
has been made to its inclinations. In thofe children, 
whofe minds have been duly regulated, the little fuf- 
ferer will be feen, when the fit is threatening, to retire 
filently to any part of the room, and there patiently 
wait the attack ; or, clinging to the knee cf its mother, 
quietly endeavour fo to regulate its breathing, as its 
hopes may defer, or moderate the violence of the ap- 
proaching convulfion. On the other hand, the un- 
fortunate darling, whofe indulgence has taught him a 
leffon, which painful experience muft correct, that he 
has a right to expect to meet with every thing accord- 
ing to his wifhes ; and who, therefore, does not feel it 
a duty to fubmit to that which is unpleafant with fomc 
degree of refignation, not only brings on the paroxyfm, 
by his petulance occafiooed by various other cauies ; 
but difplealed, and even angered at feeling the fit 
approach, his refiflance is of that violent and empaf- 
fioned kind, as to occafion the attack of the difeafe to 
come on, with increafed rapidity and violence. 

DISEASES 



MEDICAL ADMONITIONS. 497 

DISEASES OF THE SKIN, 



Children are fubject to eruptive difeafes of vari- 
ous parts of the body, the difcharge occafioned by 
which is of fuch a nature, that being applied even to 
the found fkin of the neighboring parts it will fooa 
effect a morbid change in the veflels of tttofe parts, in 
confequence of which they will fecrete a matter pof- 
feffing firnilar powers, with that by which their difeaf- 
ed action was produced. In thofe children therefore* 
who are not under a certain degree of reflraint, the 
irritation they experience in the fein occafions their 
frequent application of the nails, both to the difeaf- 
ed parts* and to the furrounding ikin ! the healthy 
ikin is therefore abraded by the nails, imbued with this 
morbid poifon, and the difeafe is hereby multiplied. 
In thofe cafes where this difeafe occurs in the face, 
the difFuiion of the exuding matter* by the frequent 
rubbing with the child's hands, is frequently fucceed- 
ed, in confequence of its application to the eye, by a 
very fevere and alarming inflammation of this part, 
which is with confiderable difficulty fubdued,. fince 
every thing is done, on the part of the patient, which 
is likely to encreafe and prolong the difeafe* 



THE MEASLES. 



A pronenefs to inflammation in the lungs, appears 

to be almofl characteriftic of this difeafe : and on the 

degree in which the inflammation of the lungs takes 

P p p place, 



493 MEDICAL ADMONITIOSr-S." 

place, will, in general, depend the degree of danger 
which accompanies the mealies. In this difeafe, there- 
fore, there can exift but little doubt, that a happy 
termination, can only be reafonably expected, where a 
moderate degree of conformity with the prefcribed 
rules, and a due moderation of the temper, can be ob- 
tained. 

Where this is not the cafe confiderable danger rauft 
arife. From thofe agitations and exertions which will 
accompany impatient endurance, an increafe of the 
difpofition to inflammation ; and even inflammatory 
action will probably proceed : and when this does 
take place, the difficulty of checking its progrefs rauft 
be obvious. 



THE SMALL POX. 



The difeafe in which a want of fufficient influence 
over the mind of a child is likely to occafion moft 
fuffering to the patient, and diilrefs to its relatives and 
attendants is the fmall pox. 

As the quantity, and even, in fome meafure, the 
degree of refinance of the fubfequent eruption will de- 
pend on the violence of the eruptive fever, the greateft 
care is necelTary that every thing be carefully avoided 
in the firft moments of the difeafe, which by irritating, 
may be likely injurioufly to augment the febrile ftate. 
But thofe only who have witneffed it can be judges of 
the difficulty with which this can be accompli fhed, in 
a child of a froward and crofs difpofition. General 

obfervation 



MEDICAL ADMONITIONS. 499 

obfervation will, however, point out the fact, that 
children of this defcripiion will, in confequence of 
their impatience and violent agitations, be loaded 
with the eruption to a much greater degree, than 
thofe children whofe pliability of temper renders 
them more eafily managable, 

" Nor is it merely in the commencement of thedif- 
eafe, that mifchief is liable to be produced by the 
/allies of impatience and petulence ; fince through 
the whole of the eruptive period, excefiive augment- 
ation of the febrile heat will mofr. frequently be fol- 
lowed by a fuperabundant crop of puftuies. 

In the more advanced ftages of this loathfome dif- 
eafe, the /cenes which the parent mufl witnefs will be 
dreadfully cqnyincing, that exceffive indulgence of 
children is generally productive of tenfold diftrefs and 
iuffering. As the eruption proceeds, a troublefome 
heat and itching of the fkin takes place ; and where 
this is not borne with a tolerable lhare of patience, the 
nails of the poor child are employ ed to overpower the 
irritation of the fkin .j but with fo much vehemence, 
that the fkin becomes more inflamed, being in parts 
even abraded, by which the number of puftuies muft 
of neceffity be confiderably multiplied. 

But when the maturation of the pock takes place, 
the mifchiefs proceeding from inability to reftrain the 
impatience of the poor tormented child become too 

t obvious 



£00 MEDICAL ADMONITIONS. 

obvious. His little hands are conftantly employed 
in rubbing the face, or fome part of the body, and 
oftentimes with fo much violence as to cnum almoft 
every puftule. The part which in general fuffers 
mofl from this fpecies of injury, is the face, which 
will frequently be mockingly lafcerated, and covered 
with the blood, and the contents of the ruptured 
puftules.* 



INOCULATION. 



The remarks which have been jufl; made, are alfo 
applicable to thole children who derive the fmall pox 
from inoculation ; fince ic too frequently happens 
that many of the advantages deriveable from the pro- 
eels of inoculation are counteracted, by the evils 

which proceed from exceilive indulgence. 

Children 

* In thofe cafes in which fach nn event is to be apprehended, parents 
mould confider that no reliance for its prevention can be placed on 
the mofl vigilant attention of the nnrfe ; fince in a moment of time, 
whilll her head is turned, the mifchief may be accomplifhed. The 
child mould therefore, by an appropriate and eafy contrivance, have 
its hands fo fee u red as to render their approach to the face impoffible. 
Parents frequentl) object to this practice, on the fufpicion that by the 
ftrugglh which the child will make to obtain a releafe hum his con- 
finement, he will injure himfelf more than he would v\ere his hands 
and arms left at liberty. But in almofl e»cry cafe where the hands 
of a child are properly fecured, a dcy or two before the maturation 
of the pock, he will indeed ftruggle lor a while ; but when he finds 
his exertions ineffectual, and that he is as it were conquered, be of 
neceffity yields to his confinement : and indeed it is often aflon'fhing 
to fee how foon, and how quietly, children ci even violent difpofi* 
tions fubra'it to this fpecies of coercion. 



MEDICAL ADMONITIONS. £OX 

Children who have been faultily indulged, are un- 
doubtedly the worfl fubje&s for inoculation that can 
be found. During that period, in "which fome de- 
gree of caution is neceffary, as to their food, it is 
much to be feared, from the eager requifitions of the 
child, and the habitual promptnefs of compliance on 
the part of the parent, that a fufticiently Arid atten- 
tion to the prefcribed regimen will not be paid. 
When the very ferious evils which in general follow 
fuch tranfgreffions are confidered, it is aftonifhing that 
they are ever committed ; but it too frequently hap- 
pens, that judgment is made to fubmit to the fug- 
geftions of overweening fondnefs. A celebrated fur- 
geon, fome years ago, inoculated two or three child- 
ren of one family in the metropolis. Each child was 
loaded with a confluent eruption, and, in fpite of 
every exertion on his part, they all died. His 
mortification may be eafily conceived to i*ave been 
very great ; nor, perhaps was it much leffened upon 
learning that, on the night preceding the fever, the 
children were allowed to fit at the fupper table, and 
partake freely of roaft fowl, wine, &c. &:c. 

It feldom happens that during the period of erup- 
tion the child is entirely free from fome degree cf in- 
convenience and pain : fome times indeed, very acute 
pain will be felt in the head, loins, or pit of the fto- 
mach. When in confequence of this producing a, 
ftrong degree of impatience, the child is incefiantly 

crying 



£02, MEDICAL ADMONITIONS. 

crying and rubbing his hands with violence over his 
eyes, and indeed the whole of his face ; the eruption, 
provoked by this irritation, will fly in considerable 
quantity to the face, and particularly to the eyelids, 
which from the friction, and the conftant application 
of the briny tears, become generally afTe&ed with 
fome flight degree of inflammation. 



CASES REQUIRING CHIRURGICAL AID. 

Children who have been thus imprudently edu- 
cated, muft be more expofed to accidents than oth- 
ers, in confequence of the little attention they gene- 
rally pay to the directions and remonflrances of their 
attendants ; but independent of this, cafes will ne« 
ceflarily arife, in which chirurgical aid will become 
jieceffary. 

Thefe are cafes, which mud too painfully convince 
the parent of the error of allowing parental influence 
to be loft. Frequently from the unconquerable tem- 
per of a child are his fufferings redoubled, and the 
mind of the fond parent more cruelly tormented. 
Ill applied tendernefs often allows the critical mo- 
ment to pafs in which, by fome trifling opera- 
tion, accompanied with a little temporary increafe of 
pain, certain relief might have been obtained ; whilft 
obftinate and violent refiitance entirely prevents the 
performance of that, by which alone, perhaps, health 

can 



MEDICAL ADMONITIONS. $Q$ 

can be reftored ; or allows it only to fuch an extent 
that the propofed intention is by no means fulfilled. 



From what has been faid above, it is hoped that 
parents will plainly perceive that the eafe, the health,, 
and even the life of their children, mud frequently 
depend on the due regulation of their paffions and 
temper, in even their infantile days, — in other words,, 
that the obtaining of fuch a degree of influence over 
the mind of a child as may procure its prompt lub- 
mimon to the will of its parents, either in yielding up 
that which may be injurious, or in acceding to that 
which, though not pleafant, may be abfolutely necef- 
fary, will greatly contribute to the prefent, as well as. 
the future comfort and tranquility, both of the par- 
ent and the child. The fond parent cannot, even 
with a little attention, avoid difcovering, that the 
object of his affection will, when thus educated, be 
the lefs likely to fall the victim of difeafe ; that 
by having been rendered thus manageable, when difr 
cafe does unavoidably occur, he will not deprive him- 
felf of the chance of recovery, by obflinately oppofing 
the efforts of art ; and that, (hould even a fatal ter- 
mination take place, his mourning relatives will not 
have to accufe themfelves with having occafioned his 
death, by having, in fact, excited that oppofition 
which the lamented object has made to every ration- 
al endeavour for his recovery, 

Other 



'£04 MEDICAL ADMONITIONS. 

Other effects on the health are produced by excef- 
five indulgence, which, though highly injurious, are 
not (o obvious as thofe which have been already 
part iculari fed. A conftant fretful nefs is generated, 
which, even during the moments that it does not 
actually break into expreflions of violence and paf- 
fion, is conftantly torturing the mind and peace j the 
digeftive powers become affected, the procefs of nu- 
trition is impeded, and the child pines under a wafting 
hectic. " Paffions," fays an elegant writer,* " arc 
" quick and ftrong emotions, which by degrees fub- 
" fide. Temper is the difpofition which remains 
" after thefe emotions are paft, and which forms 
" the habitual propenfity of the foul. The one are 
"like the ftream when it is fwoln by the torrent, and 
tc ruffled by the winds ; the other refembks it when 
*' running within its bed, with its natural force and 
" velocity. The influence of temper is more filent 
" and imperceptible than that of pafiion ; it operates 
" with left violence ; but as its operation is conftant, 
" it produces effects no lefs confiderable." 

* Dr. Elair. 



FINIS. 



CONTENTS- 



I 



Page 



NTRODUCTION •.**-— 3 

Table of Symptoms — — , .i „., 7 

Prefatory Obfervations ■ » 46 

Fever, Defcription of •• • ■■ < > S 51 

* Difficulty of making the neceffary Diftin&ions of 53 

Intermittent Fevers or Agues, 

Defcription of ■■ ~' . v ■ • ■ $6 

Ambiguity, from firft Appearance of 58 

— 1 from commencing in a continued form 59 

from fuddenly changing to a continued Fever 60 

Obfervations on the Ufe of Peruvian Bark 6 1 

Remarks on popular Remedies — — 62 

--■— Regimen and Prevention s-a 64 

Inflammatory Fever, 

Defcription of — — — - "■ "■ 66 

Danger of being milled by the firft Symptoms 67 
Neceflity of ftri<3 Attention to the Orders of thePhyfician 68 

Slow Nervous Fever, 

Defcription of ■ ■> ■ " 70 

Infidious Mode of Attack ■> > 7 1 

Perfeverance in the Endeavours for a Cure enjoined, 

as long as Life remains 7 6 

Obfervation of Dr. Buchan, Remarks on 77 

Putrid Malignant Fever, 

Defcription of ■ ; « 78 

Danger of Error in Domeflic Practitioners 80 

Q^qj*. Mifchiefs 



506 CONTENTS. 

Page 
Mifchiefs arihng from Bleeding, James's Powders, heat- 
ing Regimen, &c. 82 

Regimen and Management of the Patient, 83 

Cautions refpefting the Ufe of Wine 87 

Neceffity of ventilating the Bed- Room 89 

Directions for the Management of the Patient, whilft 

delirious — — 90 

Quotation from Dr. Blane on this Subject 91 

The Patient not to be abandoned, on the Appearance 

of thofe Symptoms ufually denoting fpeedy Death 93 
•Seeming Incapability of Swallowing accounted for, and 
the pioper Mode of adminiftering Nourifiimcnt 

pointed out — — 94 

Alarm unneceflarily excited by that which is termed 

The Rattles 95 

Prevention ■■ ■ ■ ■ 97 

Obfervations on Effluvia -■ - -- ~ 98 

Remarks on a Quotation from Dr. Gregory, adopted 
by Dr. Buchan, — — — — 99 

Cold favourable to Infection icJo 

Fumigation of Apartments 101 

Mode of employing the nitrous, marine, and acetous 
Acid, as recommended by Dr. J. C. Smyth and 
Mr. W. Blizard 101 

Danger of Infection from foul Clothing 102 

Cautions neceffary on the Return of Appetite, and on 

the Expofure to cold Air 

Mode to be adopted on the fir ft Appearances of In- 
fection 

Vital or Oxygenated Air, Benefit from 104 

Study of Chemiftry recommended — ic>4 

Infants not fo liable to Fever as Adults 105 

Remitting- 



103 
103 



CONTENTS. 507 



Remitting Fever, 

Defcription of » ' ■■■■ 

Neceffity of early attention t.o . ~~— rr- 


Page 

; 106 
- 708 


Hectic Fever, 




Defcription of 

Importance and Neceffity of d:te<Sting ks Gaufa 


109 
110 



Inflammation, 

Defcription of ■ m 

Care necefTary in felecling the Means of Cure, and in 
eftimating the Degree to which they fhould be em- 
ployed 113 
Particularly in different Stages of the Difeafe, and 
whilft the Difeafe is gliding from one Stage to 
another 11 $ 
Prevention -— — 122 
Avoiding the too fudden Tranfition to an Atmof- 
phere differing much in its Degree of Temperature, 
from that to which a Perfon has juft been expofed 124 
Danger of ufing fpirituous and heating Drinks, .ei- 
ther before, pr after Expofure to extreme Cold 1 25 
Proper Mode of Conduct fhewn 126 
Maxim — In every cafe in which pain occurs with 
fever, to obtain immediately the beft advice 127 

Inflammation of the Brain, 

Defcription of *•?<-*- 129 

Inflammation of the Eye, 

Defcription of ■ . 1 3 1 

Confequences of Neglect 132 

Blindnefs may be produced in a few Hours, if proper 

Means are not adopted — — 133 

Children, newly born, frequently blinded through im- 
proper Treatment or Inattention 136 

Th* 



508 CONTENTS. 

Page 
The Inflammatory Sore Throat, 

Defcription of 138 

Only to be removed by proper Means, employed in 

the early Stages of the Difeafe 139 

Danger of Error in Domeftic Practitioners 140 

Neceffity of frequently lubricating the Fauces 143 

The Putrid or Malignant Ulcerated Sore Throat, 

Defcription of 145 

Danger of Interference with Domeftic Medicine 146 

Regimen, and Rules for the Management of the 

Patient -— — 147 

Neceffity of Refolution and Perfeverance in the Treat- 
ment of Children 148 

The Croup, 

Defcription of 149 

Abfolute Neceffity of immediate Aid 152 

Dr. Ferriar's Remarks on this Difeafe 153 

Utility of anatomical Examinations of thofe who fall 

Victims to ambiguous Difeafes 154 

Remarks on the Objections to this Practice 155 

Prevention of the Difeafe 156 

Expofure of Children to extreme Cold highly dan- 
gerous 157 

Erroneous Calculations made on the Appearances of 

Cottage Children 159 

Two cafes mentioned, where the Difeafe feemed to be 
caufed by violent fcreaming and holloing 160 

The Mumps, 

Defcription of 161 

Fatal Termination of 16* 

Danger of Domeftic Practice, even in a Difeafe appar- 
ently trifling ■—■ — I0 "» 

Inflammation 



CONTENTS. 509 

Page 

Inflammation of the Ear., 

Defcription and Treatment of » ■* .. . 1 — 162 

Tooth Ach — ! 163 

Errors in Domeftic Practice, from confidering Tooth -ach 

as a Term expreflive of one particular Difeafe 1 64 

Tooth- Jch, the Symptom of various Difeafes of the 

Teeth, requiring different Modes of Treatment 165 

Impropriety in the ordinary Domeftic Praclice, and in 

the immediate Extraction of the Tooth — 166 

More rational Mode propefed 166 

Teething ■ 167 



NeceiTary Cautions during Dentition — — 167 

Lancing the Gums, the Neceffity of pointed out 1 68 

Tooth Necklaces a cruel Impofition 170 

Remarks on Dr. Buchan's Opinion of the Inutility of 

this Operation — — ■ 171 

Objections to the Modes of performing it recom- 
mended by Dr. Buchaa — — — • 172 

Sorenefs behind the Ears, the Treatment of — 173 

Inflammation of the Lungs 174 

Symptoms of 175 

111 Confequences arifing from an Oppofition to the 

Prefcriptions of the Phyfician 1 79 

Dr. Duplanil's Remarks on Dr. Buchan's Advice in 

this Difeafe 181 

Infidious Nature of the Difeafe ; fometimes highly dan- 
gerous without caufing Alarm 182 

When the Breathing is altered in Quicknefs, a morbid 
State of the Lungs may be fufpecled — 183 

Inflammation of the Lungs in Children, 

Defcribed _~ — a*i** 184 

The 



5I<5 CONTENTS. 

Page 
The Attention of Parents called to this Difeafe 1 85 

Alarming Symptoms, and the proper Mode of Con- 

duft pointed out 186 

Dire&ions for the Ufe of the Warm Bath — 1 86 
Cautions refpecting the Mode of applying Blifters 187 
111 Confluences of deferring the Application to Med- 
ical Men until Evening — 1 187 

Pulmonary Consumption, 

Characteri flics defcrihsd — — 189 

Regimen and Diet 191 

Remarks on Dr. Euchan's Advice as to leaving off 

Animal Food and ftrong Liquors 194 

> Dr. Cadogan's Opinion on the fame 

Subject - ■■■■ - . ■ 195 

Obfervations on the various Modes of Exercife 198 

Atmofpheric Air, compofed of oxygen and azotie Air— 

their fuppofed medicinal Powers explained 201 

Clothing, Remarks en • — — - 204 

Inflammation of the Stomach, 

Defciibed 205 

Important Remark of Dr. Crichtojj , 206 

Danger from the adoption of Domeftk Medicine 208 
Regimen, Diet, and Prevention 208 

Fatal Confequences of the Mifemployment of fpirituous 

and aromatic Drinks 208 

Probability of Family Practitioners being mifled by the 

Vomiting -r-»— 209 

Inflammation of ths Bowels, 

Defcribed —- — 2 1 1 

Danger of mi (taking it for Colickly Pains — 213 

Symptoms of Recovery and of Danger 2 1 g 

Dr. Duplanil's Remarks on Dr. Buchan's Opinion 214 

Inflammation 1 



CONTENTS* 512 

Page 

INFLAMMATION OF THE LlVEE, 

Symptoms of — — 216 

Difficulty of detecting by a Domeftic Practitioner 219 
Admonitions to the Intemperate 220 

Inflammation of the Kidney, defcribed 222 

Inflammation of the Bladber *— i 225 

Symptoms of 226 

111 Confequences arifmg from Delay 226 

Inflammation of the Spleen ,»—_»__= ft2 8 

Inflammation of the Peritoneum — 228 

May occur without exciting necenary Alarm in Do- 
meftic Practitioners — -— 238 

Remark of Dr. Baillie - — 228 

Rheumatism — - — ^ — 229 

Gout, - — ** — — 234 

Advantages derivable from the Attendance of a Phy- 
fician in this Difeafe ----- — --- 239 

Obfervations on Regimen and Diet - 2-4.0 

Opinion of Mr. Forbes on the Nature of Gout — 243 

Small Pox, — =— — — - — — 

Defcribed -■>—* — — 245 

Neceffity of real medical Knowledge in treating this 
Difeafe 250 

Numerous ridiculous Prejudices noticed 251 

Advantage of Attention to Regimen and Cleanlinefs 252 

Symptoms of Danger 254 

Danger of Blindnefs— Conduct neceffary to be adopted 255 
Opening the Puftules recommended by Dr. Buchan 256 
Remarks on this Practice by Dr. Sims — — 257 

Ill-founded Confidence of Exemption from Danger of 
Infection- ........ ....... 2 58 

I N O e V L A T i.O K 



511 CONTENTS. 

Page 
Inoculation > — -•**- 259 

Objections to it anfwered - 259 

Confequences of its being performed by Nurfes and 

Parents 262 

Obfervations on the Mode recommended by Dr. 

Buchan 264 

Remarks of Mr. Daniel Sutton 265 

Chicken or Swine Pox, 

Defcribed 266 

Neceflky of afcertaining the real Nature of the Erup- 
tion 267 

Marks by which it is diftinguifhable from Small Pox 267 

Measles — — 268 

Precarious Practice of Domeflie Medicine not to be 

trufted to in this Difeafe 269 

Inflammation of the Lungs—Danger from it— Diffi- 
culty of Detection 271 

Undeferved Cenfure of Phyficians, whence arifing 272 

Scarlet Fever, 

Defcribed — 275 

Necefiky of a nice Difcrimination in determining 
the real Nature of the Difeafe ■ 276 

Erysipelas, 

Defcribed 277 

Proper Treatment of flight Cafes 278 

More ferious Cnfes demand confiderable Judgement 280 
Mifchiefs arifing from the Employment of Goulard's 
Vegito Mineral Water — - ■ 282 

Erysipelas of Children 

The Attention of Parents called to the firft Appear- 
ances of this Difeafe ' 283 

Miliary 



CONTENTS. 513 

Page 

Miliary Fever, Obfervations on ■ 284. 

Hemorrhages, From Internal Caufes ■ ■ " ■ 288 

Dependent on numerous Caufes 289 

Dr. Cullen's Reafons for preventing the Recurrence 

of Hemorrhage ■ - 292 

Bleeding from the Nose 295 

Danger, by permitting its frequent Recurrence, of pro- 
ducing Confumption ■ 297 
The niceft Judgement neceiTary in moft Cafes when it 

happens ■ — 298 

Remarks on Dr.^Buchan's Recommendation of Liga- 
tures ©n the Limbs • 301 

Spitting of Blood — — — «—- 302 

Neceflity of diftinguifhing from what Part the Blood 
proceeds ■ 303 

Degree of Danger pointed out 303 

The Treatment of this Difeafe in no inftance to be 
trufted to Domeftic Quackery 305 

Diet, Prevention, &c. - — 305 

Hamorrhoids, or Piles, 

Defcription of -■ .. ■ 306 

Symptoms pointing out their probable Termination 

in Abfcefs and Fiftula 307 

Neceflity of Regulation in the Mode of Living 308 

111 Confequences of allowing their Progrefs, and of not 

preventing their Return 3°9 

Erroneous Opinions refpe&ing their beneficial Effecls 

on the Syftem — > 309 

Fiftulae frequently produced by negle&ed Piles 3 1 1 

Immoberate Flow of the Menses 318 

Immediate Danger and future ill Confequences fiiewn 3 1 3 

Sometimes the Symptom of fome other Difeafe 315 

R r r Vomiting 



cl± CONTENTS. 

54 Page 

Vomiting ot Blood — — 316 

Voiding of Blood from the Urinary Passages 317 

CaTAPvRH, 

Symptoms of ■ 3 l8 

Dinger arifing from Neglect, or Improper Treatment 319 
Proper Mode of 1'reatment pointed out 320 

Danger of producing Inflammation of the Lungs 

and Confumption 3 21 

A Common flight Cold, a frequent Caufe of Confumption 321 
111 Confequences from attending to the Cough only 322 
Cough Dropr, Elixirs, and other Nojlrums 324 

Too fudden Changes of the Atmofphere 325 

Clothing, in general too light, and irregularly difpofed 326 
Folly of expofmg Children too much to exceffive Cold 327 
Flannel and Fleecy Hofiery, Directions refpecling 327 
Rules for preventing Catarrh 328 

111 Confequences of receiving Company in cold and 
damp Rooms • 3 2 9 

Convulsive Asthma — — 330 

Excellent Remarks on by Dr. Bree 33° 

Diet, Obfervations on ■ 33 2 

Effects of the Atmofphere, Cold, Eaft and North- 

Eaft Winds, Storms, &c on the Afthmatic 333 

Treatment neceffary during the Fit 335 

Emetics and Bleedings, Obfervations on 337 

Blifters and Warm Bathing 33 8 

Smoke of Tobacco, its Effects 339 

Rules for the Prevention of this Difeafe 34* 

Hooping Cough — 34 2 

Obfervations on the Noftrums recommended in this 

Diforder ' — 34* 

Change of Air, beneficial EfFefts 345 

Principles 



CONTENTS. 515 
Page 

Principles fuggefted, on which this Change may be 

made ■ 346 

Dysentery, or Bloopy Flux —__ — « g^g 

Symptoms of Recovery, or of Danger 549 

Danger from permitting its too long Continuance 350 

Mode of Cure contrary to common Opinion 351 

Treatment of the Patient, 352 

Apoplexy ■ *w- 352 

Conduct to be adopted in the firft Moments of Attack 355 
Bleeding and Blifters, Obfervations on 357 

Peculiarity of Make fuppofed to predifpofe to this 

Difeafe • - • 359 

Mode of preventing the Difeafe 360 

Sleeping after a full Meal, in a Chair, Remarks on 361 
Apoplectic Fits occur during Bed-time from horizon- 
tal Poflure — — — * 363 
Apoplexy too often the Lot of the retired Citizen 364 
Deception as to the quantity of Exercife employed 365 

Palsy — . 366 

Symptoms and Caufes enumerated . 367 

Electricity, Obfervations on its Effects 369 

Fainting ■ 371 

Mode of Treatment - - 372 

Obfervations on the Mode of applying pungent O- 
dours to the Noftrils 373 

Apparent Death, - ■ 375 

From long Fading, Treatment of 375 

From Expofure to extreme Cold >— 375 

Refufcitative Procefs —— - 377 

In 



$l6 CONTENTS. 

Page 

In Cafes of Sufpenfion by the Cord 37g 

■ Suffocation by Noxious Vapours 

1 ■ — Intoxication . 



379 
379 



380 



Convulsions 

Numerous Caufes of ., ^8o 

Conduct to be adopted on the fir ft Attack 381 

Convulfions in Children, Remarks on 382 

Remarks »n the Opinion of the Inutility of Phyficians 
in Difeafes of Children 383 

Epilepsy, or Falling Sickness 385 

Treatment during the Fit 386 

Worms, Symptoms of — -■ 387 

Ambiguity of the Appearances fuppofed to denote 

their Prefence 388 

Mifchiefs arifing from Error 388 

Danger of having recourfe to advertifed Noftrums 388 

Weakness of the Stomach 389 

Symptoms and Caufes of enumerated 390 

Spirituous Liquors, injurious Effects of 391 

Remonltrances of Phyficians but too little attended to 391 
Conduct proper to be adopted 395 

Hypochondriac Affection, 

Defcribed 397 

Attention required from the Friends of the Patient 398 
Confiderable Exertions demanded of the Patient himfelf 398 
Cruelty of treating the Hypochondriac as a Subject of 
Raillery and Reproof 399 

Colic 

Colic Tinctures and Elixirs, Remarks on 400 

Danger of miftaking Symptoms of Strangulated Rup- 
ture and of Inflammation of the Bowels for thofe 
of Colic ■ 4 01 

Difficulty 



CONTENTS. 515? 

Page 

Difficulty of making the neceiTary Diftin&ion 402 

Mode to be adopted when regular Aid is not to be 
obtained — — — — -— =- 402 

Ruptures, or Hernia 

Defcribed - — — - 403 

Their Increafe dependent on the Will and Refolution 

of the Patient > 404 

May be conftantly retained 404 

TruiTes, Remarks on ■ ■ ■« 405 

Strangulated Rupture — — 407 

Life depends on immediate Reduction 407 

Danger of Exertion improperly made, and of wafting 

a Moment in domeftic Quackery 408 

Operation thereby rendered neceffary 409 

The operation much lefs painful than is generally 

imagined, and in itfelf void of Danger 410 

Duty of a Surgeon in this Cafe 410 

Rupture at the Navel ,^____„ 411 

Neceffity of early and conftant Attention 411 

Mode of treatment — — — — 413 

Ulceration of the Navel in Children 412 

Demanding the utmoft Care 412 

Cholera, Defcribed — — ■> 413 

Treatment of flight Cafes — — - 4 1 3 
Cautions refpe&ing violent Attacks in very young 

or old Perfons 414 

Diarrhoea, or Looseness 

General Mode of Treatment, Remarks on 414 

Diabetes, 

Attention called to its firft Appearances 416 

Succefsfully treated — — 4 I<5 

Hysterical 



51S CONTENTS. 

Hysterical Affections 

Danger of having recourfe to violent forcing Nof- 

trums, as Deo'oftruents a\j 

Indolence often unjuftly imputed to the Subjects of 

this Difeafe 417 

Dropsy 

Obfervations on the Employment of Noftrums in this 
Difeafe 418 

Hydrocephalus, or Watery Head, 

Symptoms defcribed — 419 

Caufes enumerated 42 1 

Cautions refpecting the Correction of Children 42 r 

Danger from Blows on the Head 422 

Mode of Defence in Cafes of Falls fuggefted 423 

The Bitb of an Hydrophobic Animal, 

Neceflity of immediate Excifion pointed out, and 
Directions refpe&ing it 423 

Scald Head, 

Defcribed ■ .„ 424 

Early affiftancc neeefTary — — - — 425 

111 Confequences of Neglect 426 

Scrofulous Swellings in the Neck produced by it 427 

Thrush, in Children, generally proceeding from impro- 
per Diet ' 427 

Dry-nurfing the moil frequent Caufe 428 

Cautions refpecting the violent rubbing affected Parts 429 

Swallowing of pins, &c. 

Proper Mode of Conduct to be adopted 43 c 

Boil, often improperly treated, and the Conftitution 

thereby injured — — 434 

Anthrax 



CONTENTS. 519 

Page 
Anthrax, or Carbuncle, 

Defcribed — *— 434- 

Danger of miftaking for a common Boil — - 434 
Importance of the early Adoption of efficacious Means 434 

Inflammation and Abscess of the Breast ■ ■ 435 

Cure may be much accelerated by furgtcal Aid — 

Hardnefs fometimes produced refembling Schirrhus 436 

Chilblains, 

Treatment of propofed, Prevention, Sec. — — 438 

Whitlow, 

Danger from — — . 440 

Neceflity of immediate Application to the fkilful Sur- 
geon — — 44 2 

Schirrhus and Cancer, 

Defcribed ■< — — 443 

Early Removal earneftly recommended 444 

Repugnance to the Operation not merely from the 

Fear of Pain 444 

Coafiderations fuggefted as likely to diminifh the dread 

of the Operation — — 444 

Cancer Cureri, pretended, Injuries they occafion — 

Remarks on the Cafes, ©n which their Fame is built 445 

Scalds and Burns, 

Applications recommended to be kept in Readinefs 449 
Linfeed Oil, improper — — — •■ .. 450 

Meafures fuggefted for Adoption, by Females, whofe 
Clothes have by Accident taken Fire — — 450 

Effusions of Blood from ruptured or wounded 

Vessels — — — ■ 452 

Situation of the large VefTels, &c. defcribed by Mr. 

Blizard — — 453 

Meafures 



/*v. 






520 TENTS. 






■ r 7-7 J r, 

Meafures to be adopted m Cafes of Accidents of this 



Nature . 



454 



Bleeding ■ 457 

Wafte of Blood from the Orifice opening afrefh 458 

Directions for its Prevention 4.58 

Leeches 

Directions for their Application and Management 459 

Curvature of the Spine 

Neceffity of abfolute Reft 461- 

Inflammation of the Hip and Knee Joint 

Caution refpecling Attention to the earlieft Symptoms 461: 
Reft enjoined 462 

Fractures of the Limbs, and Injuries of the Head 
from External Injuries. 462 

Treatment at the firft Moments of the Accident 463; 

Directions lefpe&ing the Removal of the Patient 464 

Obfervations on the improper indulgence of Children 465 




P*K 



022 169 843 5 



